RECRUITMENT PHASE: A qualified physiotherapist will check patient lists daily with the aim of
identifying suitable candidates for the study.
The patients will be enrolled from January 2020 till june 2021 and they will be stratified
individually and randomized by a dedicated software (https://www.randomizer.org/) into two
groups:
Experimental group - Chronic Obstructive Pulmonary Disease (COPD) patients in nocturnal
Non Invasive Ventilation (NIV) underwent to respiratory rehabilitation with Humidified
High Flow Nasal Cannula (HHFNC) with / without Oxygen Therapy (O2), according to medical
prescription;
Control group - patients in nocturnal NIV underwent to respiratory rehabilitation
without HFNC with / without O2, according to medical prescription.
Before randomization, individual clinical inclusion and exclusion criteria will be taken into
account in relation to the ability of each patient to tolerate the administration of the high
flow ventilation program foreseen by the study.
RUN IN PHASE: After the assessment, each patient will perform a training session prior to the
cycle ergometer, during which the subject will work on the workload and the established flow.
The intensity of the workload will be 60-80% of the Wmax, calculated with the Hill's formula:
Wmax = ( 0.122 x 6MWD) + (72, 683 x Height) - 117.109
(where 6MWD is the distance walked on the 6-minute walk test, and the patient's height must
be expressed in meters).
NIV and HHFNC will be administered through VEMO 150 (EOVE SA. 64000 Pau - France), a device
with which it is possible setting up to 4 different ventilation programs. The High Flow can
be delivered, as a continuous flow through the humidified nasal cannulas, up to 60 L / min
with or without additional oxygen therapy according to medical prescription. The patients of
the experimental group will be trained with the most adequate continuous flow, in a range
between 20 and 60 L/min, according to the maximum flow supported by the patient.
FOLLOW UP PHASE: Outpatient rehabilitation will be performed in 3 cycles, each cycle in
40-minute sessions, 3 times a week. Each session starts with the cycle ergometer with a
5-minute warm-up to an intensity of 0 watts, continues with a 30-minute resistance training
phase at a continuous target intensity (60-80% Wmax), then a warm-down of 5 minutes at an
intensity of 0 watts.
The rehabilitation will be followed by a three-month washout period, for 3 cycles.
MEASUREMENTS: We have identified four periods to evaluate gas exchange, Forced expiratory
volume in one second (FEV1) and respiratory muscle strength, dyspnea, exercise capacity, the
presence of obstructive/central sleep apnea, prediction of mortality, activities of daily
life, the impact of the disease and the quality of life.
These four periods are:
T0: baseline;
T1: at the end of the first rehabilitation cycle;
T2: at the end of the second rehabilitation cycle;
T3: at the end of the third rehabilitation cycle.
At the beginning of the study, demographics and clinical characteristics of eligible study
participants will be collected.
Patients will be evaluated for:
Blood gas analysis (BGA) in T0, T1, T2, T3;
Spirometry: Forced Vital Capacity (FVC), FEV1 and FEV1/FEVC% in T0, T3;
Questionnaire of the British Medical Research Council (MRC) modified, in T0, T1, T2, T3;
Basic / Transition Dyspnea Index (BDI / TDI), in T0, T1, T2, T3;
6 Minute Walking Distance (6MWD) with / without oxygen therapy, according to the medical
prescription during the effort, in T0, T1, T2, T3;
COPD Assessment Test (CAT) in T0, T1, T2, T3;
Night time Polygraph to detect apnea/hypopnea, in T0, T3 ;
BODE INDEX (where BODE means body mass index, obstruction of air flow, dyspnoea and
exercise capacity), in order to estimate the probability of survival, in T0, T1, T2, T3;
Saint George Respiratory Questionnaire (SGRQ) to investigate the quality of life in T0
and T3;
Evaluation of the perception of muscle fatigue and dyspnea (Borg RPE) and Visual
Analogue Scale (VAS) each session.
During training, and the run-in phase, the physiotherapist will take note of FiO2 and of the
dyspnea at the beginning and end of the session through VAS / BORG and again when the patient
will be evaluated in 6MWD).