Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is the generic name for a class of progressive pulmonary conditions that includes chronic bronchitis, emphysema, refractory asthma, and some forms of bronchiectasis. COPD patients find it difficult to breathe because of increased resistance to airflow through the lungs. The two most common forms of COPD are chronic bronchitis, which involves a long-term cough with mucus, and emphysema, which involves deterioration of the lung tissue.

Vapotherm High Velocity Nasal Insufflation (Hi-VNITM)

Vapotherm Hi-VNI is commonly used to support patients in exacerbation while in the acute care setting. Hi-VNI is a modality appropriate for use to reduce work of breathing and relieve respiratory distress.

It has a mechanism of action that uses the nasopharynx as a reservoir of fresh gas. Hi-VNI provides fresh gas for each inspiration, and adds the additional support of flushing expired CO2 out of the nasopharyngeal cavity. Because the fresh gas purges anatomical dead space, Hi-VNI increases the percentage of fresh gas in each inspiration. It also flushes CO2 out of the patient's airway. This combination of oxygen delivery and flush of expired CO2 can impact both oxygenation (e.g. hypoxia) ventilatory work (e.g. hypercapnia). Hi-VNI support may be sufficient to avoid NIPPV and/or mechanical ventilation for patients in exacerbation.

Vapotherm Hi-VNI delivers precisely blended oxygen mixtures, conditioned to ideal temperature and humidity, through a nasal cannula with flow characteristics that flush the dead space between each breath. Hi-VNI allows precise control of oxygen delivery. This precise control is particularly important in late-stage COPD patients who have become dependent on their blood oxygen levels to drive respiratory effort.

By purging anatomical dead space between breaths, Hi-VNI improves breathing efficiency that results in a decrease in the patient's respiratory rate. This reduced rate equates to less work of breathing, and therefore the ability to sustain spontaneous breathing for longer. Moreover, this reduction in respiratory rate also represents an elongation of the breathing cycle, which is important in COPD patients because they tend to trap residual lung gas due to the increased airway resistance hindering the ability to exhale. Thus, Hi-VNI facilitates the restoration to normal breathing rates and volumes.

In addition, by delivering gas that is at body temperature and saturated with water vapor, Vapotherm therapy is able to improve mucociliary function and clearing of the airway. By hydrating mucus, and countering the effects of dry oxygen therapies, Vapotherm Hi-VNI helps resolve mucus clogged airways in COPD patients and restore the natural system for airway cleaning and clearance.

Patients find the therapy very comfortable. Nurses and staff appreciate the high patient tolerance and the ability of patients on mask-free therapy to eat, drink, take their medications and interact with healthcare providers.

Clinical Use & Setting Flow Rates for Hi-VNI

The flow rate should be set to sufficiently flush the respiratory dead space between breaths. In adults this is generally 25 liters per minute or higher, depending on the size of the patient and the degree of distress. Oxygenation is managed by adjusting the FiO2. As symptoms alleviate, the patient can be weaned from the therapy by sequentially reducing the flow rates and FiO2.

Click here for details on mechanism of action and clinical use of Hi-VNI.

For information on contraindications, please visit the Precision Flow product page.


Causes & Incidence

  • The leading cause of COPD is smoking, accounting for an estimated 90% of cases. The amount a person smokes is proportional to their risk of developing COPD, however some individuals who smoke are never diagnosed with COPD.

  • Other causes of COPD include long-term exposure to other chemical and lung irritants such as industrial dust and chemical fumes.

  • 10% of COPD cases can be attributed to a genetic deficiency in protein called alpha-1 antitrypsin.

  • COPD affects an estimated 24 million people in the U.S. alone, although it is estimated that many more have symptoms of COPD, but are undiagnosed.