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Original Research: Respiratory Care |

Oxygen With Cold Bubble Humidification Is No Better Than Dry Oxygen in Preventing Mucus Dehydration, Decreased Mucociliary Clearance, and Decline in Pulmonary Function

Michelle Lisidati Franchini, MSc; Rodrigo Athanazio, MD, PhD; Luis Fernando Amato-Lourenço, PhD; Waldir Carreirão-Neto, MD, PhD; Paulo Hilario Nascimento Saldiva, MD, PhD; Geraldo Lorenzi-Filho, MD, PhD; Bruce K. Rubin, MD, MEngr; Naomi Kondo Nakagawa, PhD
Author and Funding Information

FUNDING/SUPPORT: Funding for this study was provided by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP 13/13598-1).

aDepartment of Physiotherapy, Communication Science and Disorders and Occupational Therapy, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

bPulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

cDepartment of Pathology, LIM-5, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

dFederal University of Santa Catarina, Santa Catarina, Brazil

ePediatrics Department, Virginia Commonwealth University School of Medicine, Richmond, VA

CORRESPONDENCE TO: Naomi Kondo Nakagawa, PhD, Department of Physiotherapy, Communication Science and Disorders and Occupational Therapy, LIM 34, Faculdade de Medicina da Universidade de São Paulo, Brazil, Av. Dr. Arnaldo, 455, Room 1150, Cerqueira Cesar, São Paulo, Brazil CEP 01246-903


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(2):407-414. doi:10.1016/j.chest.2016.03.035
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Background  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.

Methods  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.

Results  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.

Conclusions  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.

Trial Registry  ClinicalTrials.gov; No.: NCT02515786; URL: www.clinicaltrials.gov.

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