Automated O₂ Titration Alone or With High-Flow Nasal Cannula During Walking Exercise in Chronic Lung Diseases

Exercise-induced O₂ desaturation contributes to dyspnea and exercise intolerance in various respiratory diseases. This study assessed whether automated O₂ titration was superior to fixed-flow O₂ to improve exertional dyspnea and walking exercise endurance. We also aimed at evaluating possible additive effects of high-flow nasal cannula coupled with automated O₂ titration on these outcomes.

Subjects with chronic respiratory diseases and exercise-induced desaturation performed a 3-min constant-speed shuttle test (CSST) and an endurance shuttle walking test (ESWT) with either (1) fixed-flow O₂, (2) automated O₂ titration targeting an S_pO of 94% (± 2%), and (3) automated O₂ titration + high-flow nasal cannula according to a randomized sequence. The main outcome was Borg dyspnea score at the end of the 3-min CSST. Secondary outcomes included endurance time and dyspnea during ESWT and oxygenation status during exercise.

Ten subjects with COPD, 10 with interstitial lung disease, 5 with pulmonary hypertension, and 3 with cystic fibrosis completed the study. Compared to fixed-flow O₂, automated O₂ titration did not reduce dyspnea at the end of the 3-min CSST. Endurance time during the ESWT was prolonged with automated O₂ titration (mean difference 298 [95% CI 205-391] s, P < .001), and dyspnea at isotime was reduced. No further improvement was noted when high-flow nasal cannula was added to automated O₂ titration. Compared to fixed-flow O₂, O₂ flows were higher with automated O₂ titration, resulting in better oxygenation.

Automated O₂ titration was superior to fixed-flow O₂ to alleviate dyspnea and improve exercise endurance during the ESWT in subjects with a variety of chronic respiratory diseases. Adding high-flow nasal cannula to automated O₂ titration provided no further benefits.