Grant: CIHR Fellowship

Chronic obstructive pulmonary disease (COPD) is a disease characterized by shortness of breath, cough and sputum production. COPD worsens over time leading to debilitating complications and frequent hospitalizations. In Canada, COPD affects over 2 million Canadians -the number is expected to rise in the coming years. In under a decade, the number of Canadians diagnosed with COPD increased by 82%, now affecting 1 / 116 Canadians. COPD is the 3rd leading cause of death in the United States, causing 120,000 deaths yearly. COPD is characterized by frequent exacerbations with life-threatening breathing problems requiring management in the emergency department (ED) or intensive care unit (ICU). To relieve shortness of breath, non-invasive ventilation delivered via a mask on the face is recommended, but needs expertise, close monitoring and can be poorly tolerated. Another non-invasive device provides a heated and humidified high flow of gas with controlled oxygen fraction through nasal cannula, avoiding the need for face mask. This promising alternative has not been tested yet in this situation. We recently showed that this technique has advantages compared to non-invasive ventilation in patients with cystic fibrosis which leads to similar problems with breathing. The aim of our program is 1) to assess the potential benefits of this technique compared to non-invasive ventilation, and 2) understand the mechanisms of action in order to adapt therapy to the degree of severity. We will compare the physiologic effects and tolerance of high-flow nasal oxygen and non-invasive ventilation in patients with COPD exacerbation admitted to the ED or ICU If high-flow nasal oxygen is at least as effective as non-invasive ventilation, this could be a major advance in the treatment of COPD, potentially reducing health-care resource burden, hospital admissions and optimizing symptom control for patients. It could significantly improve the long-term management of these patients.