Specialist commentator comments
Comments on this technology were invited from clinical specialists working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.
All 5 of the specialist commentators were familiar with or had used this technology before.
One commentator felt this technology was a variation to current therapy. Three experts think myAIRVO2 is a novel and developing concept. One commentator added that nasal high-flow therapy is innovative but not new; however, the application of nasal high-flow therapy using this technology to support early discharge from hospital or as an alternative to long-term oxygen therapy or domiciliary continuous positive airway pressure (CPAP)/non-invasive ventilation in the community setting is novel. One commentator stated that the myAIRVO2 is not a new technology.
One specialist commentator stated the myAIRVO2 can improve stability of the disease. Two specialist commentators stated humidified air benefits patients by helping mucus clearance and helping to wash out CO2 from the airway dead space. One commentator concluded the main benefit of the myAIRVO2 is that humidified therapy with a high percentage of oxygen can be offered through nasal interfaces. This improves a patient's quality of life because they are able to communicate, eat and drink easily, which are limited with a face mask or with non-invasive ventilation. The high-flow aspect makes the device suitable for those patients who are extremely breathless. One specialist noted possible patient benefits such as the potential to avoid long-term supplemental oxygen therapy, domiciliary CPAP or non-invasive ventilation, the ability to relieve breathlessness at rest or during physical activity, and a reduction in complications related to non-invasive ventilation interfaces. The myAIRVO2 provides greater flexibility to titrate respiratory therapy in comparison to long-term oxygen therapy and has the potential to reduce exacerbations of chronic obstructive pulmonary disease (COPD) and prevent admission to hospital. Three commentators feel that the myAIRVO2 would be of benefit for patients having end-of-life care.
Two commentators feel there is potential for myAIRVO2 to reduce the number of COPD exacerbations and hospital admissions and the associated costs. One specialist highlighted a recent publication (Storgaard et al. 2018), citing improved admission-free survival in COPD patients treated with home nasal high‑flow therapy. One commentator stated that this technology provides another treatment option. One specialist commentator stated that there is potential for myAIRVO2 to support early discharge from hospital after exacerbation of COPD, reducing the amount of time in hospital. The same commentator also highlighted the potential to reduce costs compared with alternative domiciliary respiratory support therapies such as long-term oxygen therapy and non-invasive ventilation. One specialist outlined that it is expected that the community staff and service needs will be similar to home oxygen or non-invasive ventilation. There is also potential that there would be a little more pressure on the outpatient services that would support the equipment – such as home ventilation services.
Specialist commentators identified a diverse range of patient groups for whom myAIRVO2 could be suitable, some of which are outside the scope of this briefing. In the community, this device may be considered for some patients with bronchiectasis or cystic fibrosis and in patients with a tracheostomy with thick tenacious secretions needing humidification. One expert concluded that myAIRVO2 and nasal high-flow therapy is a developing field, which appears to be having a real impact on patient care. One expert advised that to address some of the uncertainty in this promising technology, UK-based research exploring clinical outcomes (for example, length of stay, hospital admissions, rates of exacerbations, antibiotic and steroid use, arterial blood gas measurements, patient-reported outcomes) as well as an economic evaluation should be done. This could include a more detailed cost comparison for a patient cohort. Studies should also address the following:
Directly comparing the use of AIRVO2 in comparison to each of long-term oxygen therapy and non-invasive ventilation across a range of specific clinical states.
Exploring the role of AIRVO2 specifically for early supported discharge following exacerbation of COPD.
Exploring the role of AIRVO2 specifically when long-term oxygen therapy is not tolerated/adhered to or non-invasive ventilation is not tolerated/adhered to.