Humidified High Flow

"Breathe Easier" with Warm, Humidified Air at Home

This might be the missing link to optimizing your COPD therapy and improving your symptoms

Humidified high flow therapy (HHFT) is used widely in hospitals for people with severe breathing conditions, such as flare-ups of chronic obstructive pulmonary disease (COPD).

This therapy provides a high flow of air that is heated up to 37°C and humidified. The setup consists of a small tabletop machine, a breathing tube, and small silicone nasal prongs (called nasal cannulas) that deliver humidified air into the user’s nostrils.

 

In hospitals, HHFT is usually set at high flow rates of up to 60 litres per minute. At these flow rates, the air flow rushes into the airways to help with both breathing and oxygenation. Newer studies are examining the benefits of using HHFT at home at lower flow rates (usually around 20–30 litres per minute) to prevent COPD flare-ups.

 

If despite your current medications, you feel your breathing symptoms aren’t well controlled, especially if you have excess mucus, coughing, and breathlessness, ask your doctor if you may benefit from HHFT.

How does it look like?

Humidified High Flow
with F&P myAIRVO
<div class="title">Humidified High Flow<br />
with F&P myAIRVO</div>

How does humidified high-flow therapy help with COPD?

To understand how HHFT helps with COPD, it’s important to first understand the role of mucus: It is actually a defense mechanism meant to trap dust, viruses, and bacteria. When the body can’t clear mucus out of the lungs and air passages, it can lead to a higher risk of infection.

 

The mucociliary transport system is the name of the body’s mucus-clearing system. Its job is to move mucus out of the body, but it becomes less effective when exposed to inhaled toxins, smoke, fumes, or even dry air since it dries out mucus and therefore makes it difficult to transport out of the body.

People living with COPD often have poor mucus clearance. This means they may have:

• Frequent cough because they struggle to move the mucus stuck in their lungs
• Productive cough to bring up loosened mucus from the lungs
• Recurring upper respiratory lung infections since trapped mucus is a breeding ground for bacteria and viruses in the lungs
• Shortness of breath due to narrowed airways or obstructions from the inflammation and mucus in the airways

Humidified air may improve these symptoms by loosening mucus and encouraging the body’s ability to cough up excess phlegm. A 2010 study found that people with COPD who used a HHFT similar to the myAIRVO™ system for just 1 hour and 40 minutes per day had fewer, shorter flare-ups and required fewer antibiotics. Other studies have shown that longer daily uses of the therapy have even more benefits.

 

For example, in a 2018 study of 200 people with COPD, those who received humidified high-flow therapy with myAIRVO for 6 hours a day over 12 months had a better quality of life with fewer symptoms, exacerbations, and hospital admissions.

In a follow-up study, some of the patients were asked about their experience with myAIRVO. Six common benefits emerged:

• Fewer COPD symptoms
• Perceived lower work of breathing
• Increased ability to perform activities of daily living
• Improved quality of sleep
• Feeling safe
• Easy-to-use equipment

 

Another study followed patients for 6 weeks of treatment with humidified high-flow oxygen therapy. The results showed less buildup of carbon dioxide in their blood and improved health-related quality of life with patients reporting fewer symptoms.

How is humidified high-flow therapy different from other therapies?

There are various medical device systems available for patient use—the right one for you will depend on your condition and symptoms.

Oxygen therapy is prescribed when the oxygen levels in the blood are too low, and it helps maintain safe levels of oxygen in the body.

Oxygen therapy is commonly delivered via small silicon tubes in the nostrils called nasal cannulas.

Although it can help with feeling less out of breath, oxygen therapy alone will not help with mucus and coughing.

Bilevel Positive Airway Pressure (BPAP) is especially helpful for people with COPD who have high levels of carbon dioxide in the blood because the air they need to breathe out gets trapped in the lungs.

BPAP therapy pushes a high pressure of air into the lungs to inflate them to their maximum potential, similar to blowing up a balloon. It then switches to a lower pressure to help push trapped air out of the lungs. This increases the amount of oxygen available and forces out trapped carbon dioxide.

BiPAP is more cumbersome than oxygen therapy with nasal cannulas as it requires a sealed mask around the mouth and/or nose.

Humidified high-flow therapy (HHFT) is usually prescribed for patients who tend to struggle with cough and excess mucus. This therapy hydrates the airways—which can’t be done as effectively with BPAP or oxygen therapy. It also provides a little bit of pressure to open the airways.

Patients often describe the therapy as more comfortable than BPAP because it doesn’t require a sealed mask on the face, just nasal cannulas. Because of this, you can eat, drink, and talk while using it. It can be used anytime, whether you’re awake or asleep, and it is portable.

A 2021 medical study compared people who used only oxygen to those who used it along with myAIRVO over 52 weeks. People using only oxygen reported an average of 2–3 flare-ups per year. Those using oxygen and myAIRVO reported only 1 flare-up per year. They also reported improved quality of life in the first 24 weeks of myAIRVO use.

Reducing the number of COPD flare-ups is key to slowing the progression of the disease, and the studies mentioned above show that HHFT is an effective way to accomplish this.

Side Effects

There are very few side effects or complications to humidified high-flow therapy—actually, studies show that people’s symptoms often improve with using it more.

 

It might take some time to get used to the warmer air but most people adapt quite easily. It is a “softer therapy” and can be used in conjunction with BPAP and oxygen therapy.

To get control of a severe exacerbation, doctors need to stabilize a person’s oxygen levels, reduce lung inflammation, and eradicate infections. The person may also need additional treatment to support their heart, blood pressure, or other organs. This usually requires many different treatments and possibly several days in the ICU.

 

Recovery from a severe COPD exacerbation may take days to weeks to even months. Once recovered from a COPD exacerbation, people should meet with their health care team to determine whether there is anything they can do to prevent the next episode. Some people with severe COPD may be referred to a respirologist (lung specialist) and may receive prescriptions for daily antibiotics. An exacerbation often leads to a referral to pulmonary rehab. Others with severe COPD may even be referred for surgery to help remove damaged portions of the lungs.

Curious about how to prevent COPD flare-ups?

Find out why they happen—and how to reduce their frequency — in this article.

FAQ

Frequently Asked Questions

Humidified high-flow therapy systems like myAIRVO™ use one steady rate of airflow rather than switching between high and low air pressures. Also, what you wear on your face is different. With BPAP, a mask is worn that needs to be sealed tightly to the face. On the other hand, myAIRVO uses nasal cannulas, which do not require a seal. Studies comparing the two therapies often describe HHFT as more comfortable since it’s easier to wear and can be used while talking and even eating.

Also, some patients on BPAP might struggle with the very high pressures of air the machine produces. For example, the pressure for inhaling with a BPAP machine may be set to 20 cm H2O (a measure of pressure). With HHFT, the pressure of air is only about 2–3 cm H2O when set at an airflow rate of 20–30 litres per minute.

Finally, some users feel warmer with HHFT than with BPAP. That’s because BPAP doesn’t warm the air as much.

Unlike oxygen therapy, there is no federal or provincial funding available in Canada for HHFT systems because they are still quite new.

Some private insurance companies will reimburse the cost, depending on the provider and policy. The price for purchasing an HHFT system is between $3,500 and $4,500, while a rental usually costs $300 to $400 per month.

Yes! As COPD gets more severe, some people require home oxygen therapy—which can be used along with humidified high-flow therapy. Some patients using home oxygen may benefit from using HHFT since it combines oxygen with humidification.

Yes. HHFT is helpful, especially if you struggle with lots of mucus production and shortness of breath, even if you are technically considered to have mild COPD. So far, most clinical studies about HHFT have focused on its effect in patients with severe COPD who have hypoxemia and/or hypercapnia. However, people with milder forms of COPD may also benefit from HHFT.