Why, whether and how to use high-flow nasal therapy in acute exacerbations of chronic obstructive pulmonary disease

Noninvasive ventilation (NIV) represents the standard of care for respiratory support of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) developing acute hypercapnic respiratory failure (AHRF) [1]. NIV has been shown to reduce patient’s work of breathing and mortality and be feasibly implemented in various hospital location facilities at different timing, based on the severity of AHRF [2] and it is also widely used in clinical practice by physicians [3]. However, clinicians’ knowledge, experience and expertise in the management of NIV are crucial for its success in order to overcome common problems that may lower its effectiveness such as patients’ discomfort due to the interfaces (e.g., tight-fitting face masks), excessive air leaks from the masks and patient–ventilator asynchrony. Thus, despite improvements in mask and ventilator technology to enhance patients’ comfort and clinicians’ optimization of ventilator settings to improve patient–ventilator interactions, NIV tolerance is still a major issue that can cause NIV failure with rates ranging from 5 to over 50% [4]. The relatively recent introduction into clinical practice of high-flow nasal therapy (HFNT) as a new noninvasive respiratory support led to growing reports on the potential role of this technique in these settings