Benefit of High-flow Nasal Cannula on Persistent Dyspnea in Ild

N/ANot Yet RecruitingNCT06617078

Assistance Publique - Hôpitaux de Paris42 enrolled

Overview

The main purpose of this study is to evaluate the effects of high-flow nasal therapy (HFNT) oxygen compared to long-term oxygen therapy (LTOT) on dyspnea and quality of life in intersititial lung disease patients with chronic respiratory failure and persistent breathlessness in whom LTOT has already been initiated.

The study will be a non-blinded, two-arm, crossover (2 periods of 2 weeks each), randomised controlled superiority multicentre trial comparing the effect of HFNT on persistent dyspnoea in intersititial lung disease patients with chronic respiratory failure as compared to LTOT over a two-week period. The oxygen flow rate with HFNT will be the same as for usual care. The HFNT will be used during the night and during the 3-minute chair rise test, it can be used during the day depending on the patient's needs. During the rest of the time, the LTOT will be used as in usual care. Participants will be randomised to receive (1) 2 weeks of LTOT then 2 weeks of LTOT+HFNT or (2) 2 weeks of LTOT+HFNT then 2 weeks of LTOT. The investigators will determine the effect of HFNT on quality of life and dyspnoea. The investigators will also study the effect of HFNT on secondary outcomes listed below. Each assessment will be performed at the end of each 2-week period. Polysomnography will be optional. The study will be conducted in 42 patients with LTOT suffering from persistent breathlessness. With a total sample of 38 patients and a crossover design, if the real difference on the Saint George's Respiratory Questionnaire (SGRQ) is 6, the standard deviation of the matched difference is 12.5 and the significance threshold is 5%, a two-tailed Student's t test will have a power of 80% to conclude that the difference is significantly different from 0 (Calculated using PASS 14.0.14, Analysis of a cross-over design using difference).These hypotheses are based on the values observed in the article by Nagata et al. (PMID: 29283682), in patients with Chronic Obstructive Pulmonary Diseaes of the same severity, which reported an improvement in the SGRQ-s of -10.8 (95% CI: -15.3; -6.3, i.e. SD of 12.4) with HFNT administered at night for 6 weeks versus LTOT Another study (PMID: 31308647) reported an improvement of -11.9 (CI95% -17.2; -6.6) after an introduction of HFNT. As the minicmal clinical improvement difference for SGRQ is 4, a difference of 6 is considered was both realistic and clinically relevant. A Student's t test allows a conservative approach compared to the use of a linear mixed-effects model retained for the analysis of the primary endpoint. To take account of reduced precision due to possible loss of follow-up or study withdrawals, the sample was increased by 10%, i.e. 42 patients: 21 in the HFNT+LTOT then LTOT sequence and 21 in the LTOT then HFNT+LTOT sequence.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

ILD

Interventions

long-term oxygen therapy (LTOT)PROCEDURE

Usual care with LTOT for 2 weeks

High Flow Nasal Therapy (HFNT)PROCEDURE

High Flow Nasal delivered by myAirvo3 (4 hours minimum and during th 3-minute chair rise test, 30L/min, 34°C, identical O2 flow rate as LTOT) for 2 weeks

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Intertitial lung disease * Persistant dyspnea (mMRC≥3) * Long-term oxygen therapy at least for 3 months Exclusion Criteria: * Chronic respiratory disease (COPD, lung cancer) * Pneumothorax, * Pneumomediastinum, * Active smoker, * Patient on non-invasive ventilation or continuous positive airway pressure (CPAP), * Pregnancy or breastfeeding, * Unable to read or understand questionnaires, * No written consent, * Patients under guardianship, * No health assurance coverage

Outcomes

Primary Outcomes

SGRQ questionnaire : Saint George's Respiratory Questionnaire (symptom component)

Symptom component of SGRQ : Scores range from 0 to 100, with higher scores indicating more limitations.

Time frame: 2 weeks

Secondary Outcomes

Dyspnea assessement : dyspnoea-12

Dyspnea-12 score range from 0 to 36, with higher score indicating worse breathlessness

Time frame: 2 weeks

Dyspnea assessement : mMRC: Modified Medical Research Council

mMRC score : range frome 0 (low) to 4(high) and assesses the intensity of dyspnea

Time frame: 2 weeks

Dyspnea assessement : MDP: Multidimensional dyspnea profile

* Immediate affective score range from 0 to 10 with higher score indicating worse breathlessness * Sensory score range from 0 to 50 with higher score indicating worse breathlessness * Emotional score range from 0 to 50 with higher score indicating worse breathlessness

Time frame: 2 weeks

Quality of life (SGRQ questionnaire) : S.George&#39;s Respiratory Questionnaire

* Total score range from 0 to 100 with higher score indicating more limitations * Activity subscore range from 0 to 100 with higher score indicating more limitations * Impact sub-score range from 0 to 100 with higher score indicating more limitations

Time frame: 2 weeks

Quality of life (K-Bild) : The King's Brief Interstitial Lung Disease (KBILD) questionnaire

Total score range from 0 to 100 with lower score indicating more limitations

Time frame: 2 weeks

Quality of life questionnaire (SF12): Short Form 12

Central Contacts

Capucine Morélot-Panzini, MD,PhD, Prof

CONTACT

0142167771 capucine.morelot@aphp.fr

Anne Radenne

CONTACT

0142161699 anne.radenne@aphp.fr

Data from ClinicalTrials.gov

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