Impact of High-Flow Nasal Cannula for Chronic Obstructive Pulmonary Disease Exacerbation: A Systematic Review of Clinical and Physiological Outcomes

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• Picked for Critical Care and Intensive Care Medicine (top studies of the week, 26 July 2026): High‑flow nasal cannula systematic review in COPD
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• Picked for Physiology (medical) (paper of the day, 20 July 2026).
• Picked for Pulmonary and Respiratory Medicine (paper of the day, 20 July 2026).

Abstract

BACKGROUND: Chronic obstructive pulmonary disease (COPD) caused 3.72 million deaths in 2021. Exacerbations drive morbidity and hospital admissions. Conventional oxygen therapy (COT) offers limited support, while non-invasive ventilation (NIV) improves outcomes but is often poorly tolerated. High-flow nasal cannula (HFNC) delivers heated, humidified oxygen at high flow rates, improving gas exchange and comfort. This systematic review (PRISMA-guided) examines HFNC use in acute and chronic hypercapnic COPD compared with COT and NIV. METHODS: Systematic searches of MEDLINE, Embase and CENTRAL (to 2025) identified 14 primary studies (7 randomized trials, 7 observational cohorts). Physiological, clinical and patient-reported outcomes were extracted. Risk of bias was evaluated using RoB 2 and ROBINS-I. RESULTS: In acute settings, HFNC consistently improved PaCO2 and reduced respiratory effort versus COT, lowering treatment failure (10.0% vs 19.4%, p=0.026). However, HFNC failed non-inferiority versus NIV for treatment failure (25.7% vs 14.3%) and showed higher intubation (14.2% vs 5.4%, p=0.026). Domiciliary HFNC reduced annual exacerbations and improved quality of life (SGRQ mean difference -8.12). CONCLUSION: HFNC provides physiological benefits and lowers short-term failure versus COT and reduces home exacerbations. However, it is less effective than NIV for severe hypercapnic failure. HFNC should be reserved for mild-to-moderate exacerbations or NIV-intolerant patients, with close monitoring and predefined escalation criteria.

Abstract as published, via PubMed.