Clinical and Radiological Evolution of Bronchiectasis Treated with Long-Term High Flow Nasal Therapy: The Impact of...

Background and Objectives: a "vicious vortex" model was proposed to explain the pathophysiology of bronchiectasis, incorporating abnormal mucus, altered mucociliary clearance and chronic inflammation. Evidently, airway clearance needs to be implemented in the patient's daily routine for a protracted period in order to ameliorate the clinical outcomes. High Flow therapy (HFT) has several physiologic effects and represents a valid therapy for various respiratory diseases. The aim of this study is to assess clinical and radiologic effects of long-term HFT in adult non-CF bronchiectasis. Materials and Methods: This is a retrospective observational cohort study including adult patients affected by bronchiectasis and frequent exacerbations and hospitalizations. A chest HRCT was performed, and a quantitative evaluation of the scans was conducted applying a modified Bhalla score of five items. A total of 44 patients completed the follow up, 23 in the HF-group and 21 in the controls (No-HF group). Results: The median follow up was 41 months (range 36-48 months). The mean age was 65 years, 45% were females. After treatment the annual rate of exacerbations was significantly lower in the HF group (1.2 ± 0.95 versus 3.5 ± 1.0 per year, p < 0.0001). The annual rate of hospitalizations was significantly lower in the HF group (0.4 ± 0.52 versus 1 ± 0.93 per year, p = 0.01). The total score of the modified Bhalla improved after treatment in the HF group with a mean score of 5.32 versus 8.38, p = 0.034. The difference was substantially due to the lower score of mucoid impactions in the HF group. Conclusions: Bronchiectasis is an evolutive disease. Long-term HFT reduces the annual rate of exacerbation and hospitalization. In addition, HFT prevents mucoid impaction and potentially influences the radiological evolution of the disease.