Department of Physiotherapy, Communication Science and Disorders and Occupational Therapy, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Chest. 2016 Aug;150(2):407-14. doi: 10.1016/j.chest.2016.03.035. Epub 2016 Apr 2.
Little is known about the effects of long-term nasal low-flow oxygen (NLFO) on mucus and symptoms and how this variable is affected by dry or cold humidified gas. The aim of this study was to investigate the effects of dry-NLFO and cold bubble humidified-NLFO on nasal mucociliary clearance (MCC), mucus properties, inflammation, and symptoms in subjects with chronic hypoxemia requiring long-term domiciliary oxygen therapy.
Eighteen subjects (mean age, 68 years; 7 male; 66% with COPD) initiating NLFO were randomized to receive dry-NLFO (n = 10) or humidified-NLFO (n = 8). Subjects were assessed at baseline, 12 h, 7 days, 30 days, 12 months, and 24 months by measuring nasal MCC using the saccharin transit test, mucus contact angle (surface tension), inflammation (cells and cytokine concentration in nasal lavage), and symptoms according to the Sino-Nasal Outcome Test-20.
Nasal MCC decreased significantly (40% longer saccharin transit times) and similarly in both groups over the study period. There was a significant association between impaired nasal MCC and decline in lung function. Nasal lavage revealed an increased proportion of macrophages, interleukin-8, and epidermal growth factor concentrations with decreased interleukin-10 during the study. No changes in the proportion of ciliated cells or contact angle were observed. Coughing and sleep symptoms decreased similarly in both groups. There were no outcome differences comparing dry vs cold bubble humidified NLFO.
In subjects receiving chronic NLFO, cold bubble humidification does not adequately humidify inspired oxygen to prevent deterioration of MCC, mucus hydration, and pulmonary function. The unheated bubble humidification performed no better than no humidification.
ClinicalTrials.gov; No.: NCT02515786; URL: www.clinicaltrials.gov.
对于长期接受低流量鼻氧（NLFO）治疗对黏液的影响以及该变量如何受到干燥或冷湿化气体的影响，我们知之甚少。本研究旨在探讨干燥 NLFO 和冷气泡湿化 NLFO 对需要长期家庭氧疗的慢性低氧血症患者的鼻腔黏液纤毛清除率（MCC）、黏液特性、炎症和症状的影响。
18 名开始接受 NLFO 治疗的受试者（平均年龄 68 岁；7 名男性；66%患有 COPD）被随机分为接受干燥-NLFO（n=10）或湿化-NLFO（n=8）组。通过糖精传递试验测量鼻腔 MCC，通过测量鼻灌洗液中的细胞和细胞因子浓度评估炎症，通过 Sino-Nasal Outcome Test-20 评估症状，在基线、12 小时、7 天、30 天、12 个月和 24 个月时对受试者进行评估。
在整个研究期间，两组的鼻腔 MCC 均显著下降（糖精传递时间延长 40%），且下降幅度相似。鼻腔 MCC 受损与肺功能下降之间存在显著相关性。鼻灌洗液中巨噬细胞比例、白细胞介素-8 和表皮生长因子浓度增加，白细胞介素-10 浓度降低。未观察到纤毛细胞比例或接触角的变化。两组的咳嗽和睡眠症状均有类似程度的改善。干燥与冷气泡湿化 NLFO 之间的结果无差异。
在接受慢性 NLFO 治疗的患者中，冷气泡湿化无法充分湿化吸入的氧气，从而无法防止 MCC、黏液水合作用和肺功能恶化。未加热的气泡湿化效果并不优于无湿化。
ClinicalTrials.gov；编号：NCT02515786；网址：www.clinicaltrials.gov。
