Research question:

This study aims to assess the benefit of self-administered high-flow therapy (HFT) in comparison with standard treatment without HFT in patients with stable, advanced chronic obstructive pulmonary disease (COPD) or in patients with chronic respiratory failure (CRF) type 1 with regard to patient-relevant outcomes. Self-administration is suitable for the home environment, at nursing facilities, at rehabilitation clinics, or at facilities of statutory health insurance physicians.

Conclusion:

On the basis of 1 study on HFT in COPD associated with CRF type 1, no hint of any greater benefit or harm of oxygen administration via HFT in comparison with oxygen administration via mask was found when administered repeatedly during physical exercise. It remains unclear whether a comparable benefit might be present. Data from 1 study on the long-term use of HFT were unusable because only a subgroup of patients suffered from CRF type 1 and therefore received an appropriate comparator therapy.

For the application of HFT in comparison with oxygen administration alone in patients with CRF type 1 and an underlying disease other than COPD, 1 study with repeated application during exercise was found. The data were unusable for a benefit assessment.

Regarding the use of HFT in patients with COPD and CRF type 2, usable data were available from 1 included study. This study revealed no benefit or harm of HFT in comparison with noninvasive ventilation. Since the data of the study are difficult to interpret, it remains unclear whether a comparable benefit exists.

For COPD without CRF symptoms, data were available from only 1 study and unsuitable for a benefit assessment.

Across indications, the data do not suggest any harm of HFT.

For all 4 indications, both completed and ongoing randomized controlled trials (RCTs) were found for assessing HFT. From the described results of all included studies – i.e., with additional consideration of the studies not usable for the benefit assessment – it follows that the HFT method to be assessed has the potential of a required treatment alternative. Testing in initially 2 studies is deemed feasible and meaningful.

Publisher

Institute for Quality and Efficiency in Health Care

Topic

Self-administered high-flow therapy in advanced chronic obstructive pulmonary disease or chronic type 1 respiratory failure

Commissioning agency

Federal Joint Committee

Commission awarded on

11 June 2020

Internal Commission No.

N20-02

Address of publisher

This report was prepared in collaboration with external experts.

The responsibility for the contents of the report lies solely with IQWiG.

According to §139b (3) No. 2 of Social Code Book (SGB) V, Statutory Health Insurance, external experts who are involved in the Institute’s research commissions must disclose “all connections to interest groups and contract organizations, particularly in the pharmaceutical and medical devices industries, including details on the type and amount of any remuneration received”. The Institute received the completed Form for disclosure of potential conflicts of interest from each external expert. The information provided was reviewed by a Committee of the Institute specifically established to assess conflicts of interests. The information on conflicts of interest provided by the external experts and external reviewers is presented in Chapter A10 of the full report. No conflicts of interest were detected that could endanger professional independence with regard to the work on the present commission.

External experts

• Wolfram Windisch, Lung Hospital, Hospitals of the City of Cologne

IQWiG thanks the external expert for his collaboration in the project.

IQWiG employees

• Lina Rodenhäuser
• Daniela Rüttgers
• Moritz Felsch
• Ulrike Lampert
• Martina Markes