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Naomi Kondo Nakagawa, PhD; Rodrigo Athanazio, MD, PhD; Bruce K. Rubin, MD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

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

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

cChildren’s Hospital of Richmond at Virginia Commonwealth University, 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, Rm 1150, Cerqueira Cesar, São Paulo, Brazil, CEP 01246-903


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


Chest. 2016;150(3):750-751. doi:10.1016/j.chest.2016.06.040
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We thank Drs Vargas and Esquinas for their interest in our manuscript. We fully agree that a third study arm including heated humidification would have provided a worthy comparison. Indeed, we have previously published that in infants receiving chronic oxygen therapy, heated humidification reduced the work of breathing and improved clinical outcomes when compared with a heat and moisture exchanger. Minimal adequate air humidification during invasive mechanical ventilation is reported to be 30 mg H2O/L. This is 50% greater humidity than that provided by the cold bubble humidifier in our study. However, the 2015 British Thoracic Society guidelines still state that humidification is unnecessary for patients receiving nasal low-flow oxygen therapy. The additional cost of a heated humidifier during nasal low-flow oxygen therapy is not covered by Brazilian Government Health Insurance, making our results most representative of the British Thoracic Society guidelines and of actual practice here. We were, therefore, also unable to obtain heated humidifiers for this study.

Nearly all of our subjects had moderate or severe obstructive pulmonary disease by American Thoracic Society/European Respiratory Society criteria and required home oxygen therapy for chronic hypoxemia. The nasal mucociliary clearance deterioration over time was associated with lung function decline, so this was likely to be a result of both insufficient humidification of inspired air and disease progression. Because all subjects needed oxygen therapy, it was impossible to have a control group receiving no therapy that would allow us to more directly identify the impact of drier inspired air on nasal mucociliary clearance.

References

Franchini M.L. .Athanazio R. .Amato-Lourenço L.F. .et al Oxygen with cold bubble humidification is no better than dry oxygen in preventing mucus dehydration, decreased mucociliary clearance, and decline in pulmonary function. Chest. 2016;150:407-414 [PubMed]journal. [CrossRef] [PubMed]
 
McNamara D.G. .Asher M.I. .Rubin B.K. .et al Heated humidification improves clinical outcomes, compared to a heat and moisture exchanger in children with tracheostomies. Respir Care. 2014;59:46-53 [PubMed]journal. [CrossRef] [PubMed]
 
Ricard J.D. .Boyer A. . Humidification during oxygen therapy and non-invasive ventilation: do we need some and how much? Intensive Care Med. 2009;35:963-965 [PubMed]journal. [CrossRef] [PubMed]
 
Hardinge M. .Annandale J. .Bourne S. .et al British Thoracic Society Guidelines for home oxygen use in adults. Thorax. 2015;70:i1-i43 [PubMed]journal. [CrossRef] [PubMed]
 
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of COPD. United States; 2015.http://www.goldcopd.it/materiale/2015/GOLD_Report_2015.pdf. Accessed July 22, 2016.
 

Figures

Tables

References

Franchini M.L. .Athanazio R. .Amato-Lourenço L.F. .et al Oxygen with cold bubble humidification is no better than dry oxygen in preventing mucus dehydration, decreased mucociliary clearance, and decline in pulmonary function. Chest. 2016;150:407-414 [PubMed]journal. [CrossRef] [PubMed]
 
McNamara D.G. .Asher M.I. .Rubin B.K. .et al Heated humidification improves clinical outcomes, compared to a heat and moisture exchanger in children with tracheostomies. Respir Care. 2014;59:46-53 [PubMed]journal. [CrossRef] [PubMed]
 
Ricard J.D. .Boyer A. . Humidification during oxygen therapy and non-invasive ventilation: do we need some and how much? Intensive Care Med. 2009;35:963-965 [PubMed]journal. [CrossRef] [PubMed]
 
Hardinge M. .Annandale J. .Bourne S. .et al British Thoracic Society Guidelines for home oxygen use in adults. Thorax. 2015;70:i1-i43 [PubMed]journal. [CrossRef] [PubMed]
 
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of COPD. United States; 2015.http://www.goldcopd.it/materiale/2015/GOLD_Report_2015.pdf. Accessed July 22, 2016.
 
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