The myAIRVO2 system delivers warmed and humidified respiratory gases, including at high-flow rates. It includes a humidifier with an integrated flow generator that is designed for use in patients who are breathing without help and has interfaces to suit both upper and bypassed airways (tracheostomy patients). Other features of myAIRVO2 are that it allows clinicians to titrate flow (from 10 to 60 litres/min on adult mode) and oxygen independently from one another and does not need a sealed interface. The product is marketed as AIRVO2 and myAIRVO2. myAIRVO2 is a device that is being used in the home or other domiciliary care environment. This briefing focuses on myAIRVO2 delivering nasal high-flow therapy for treating chronic obstructive pulmonary disease (COPD), including in a community setting.
myAIRVO2 differs from standard respiratory gas devices in being designed to allow the delivery of nasal high-flow therapy in a community setting. It also uses room air, removing the need for piped medical air, and humidifies the delivered air to reduce the risk of dryness and trauma to the upper airway mucosa.
The NICE guideline on chronic obstructive pulmonary disease recommends treatment options including smoking cessation, inhaled therapy, oral therapy, oxygen therapy, non-invasive ventilation, pulmonary rehabilitation and surgery.
The guideline makes detailed recommendations for patient selection and use of long-term oxygen therapy and non-invasive ventilation. The guideline does not include recommendations on nasal high-flow therapy as an alternative or adjunct to these interventions.
The British Thoracic Society guideline on oxygen use in adults in healthcare and emergency settings highlights that, as part of good clinical practice, high-flow nasal oxygen should be considered as an alternative to reservoir mask treatment in patients with acute respiratory failure without hypercapnia.
The place in treatment of myAIRVO2 in a community setting is uncertain because patient selection for nasal high-flow oxygen (or oxygen-enriched gases) isn't well defined. It could be used in place of, or as well as, long-term oxygen therapy or non-invasive ventilation.
myAIRVO2 would be prescribed by a healthcare professional and administered by a carer or community nursing staff or the patient themselves.
myAIRVO2 costs £2,475 (including 3 filters) and has a lifespan of 5 years with no additional servicing costs or needs. The consumable components cost £136 per patient per 2‑month period and £9 per filter, which needs replacing every 3 months or 1,000 hours of use. Based on these costings, the total device costs of myAIRVO2 are £1,320 per patient in the first year and £1,347 in the remaining 4 years.
Nasal high-flow therapy is not routinely delivered in a community setting in the NHS so direct comparative costs are not available. Interventions that myAIRVO2 might replace or be used alongside include a domiciliary non-invasive ventilation service (£2,373 in the first year, excluding device costs, and £1,536 in subsequent years [Dretzke et al. 2015]).
myAIRVO2 would represent an additional cost to standard care, which could potentially be offset if it resulted in a reduction in exacerbations, admissions to hospital, or antibiotic use. Other cost savings may be possible if myAIRVO2 helps support early discharge from hospital. myAIRVO2 is for use in the patient's home and in community care facilities. It is anticipated that introducing this technology for community-based patients would need some pathway redesign with changes in resourcing because of this.