ClinicalTrials.gg
RecruitingNCT07065799RESPHYCUpdated Jul 15, 2025

Respiratory Strategies in COPD Patients With Persistent Hypercapnia Following Exacerbation

An interventional study of Group 1: NHF/LTOT and Group 2: HMV/LTOT in COPD, Hypercapnia and Exacerbation Copd, sponsored by IRCCS Azienda Ospedaliero-Universitaria di Bologna. Recruiting at 5 sites in Italy. Open to participants aged 18 Years to 90 Years. Per ClinicalTrials.gov, last updated 2025-07-15.

Sponsored by IRCCS Azienda Ospedaliero-Universitaria di Bologna · Not applicable, Interventional, and Treatment

From the registry’s dates

  • Started Jun 2024; still recruiting 2 years 4 months later.
Phase
Not applicable
Study type
Interventional
Enrollment
31
Allocation
Randomized
Ages
18 Years to 90 Years
Sex
All
01

Where this study stands

Counted across the records on this site · 2026-11-12

Among 12 studies in Pulmonary Disease, Chronic Obstructive by IRCCS Azienda Ospedaliero-Universitaria di Bologna — 4 open to participants now, 4 under way, none of them phase 3. Pulmonary Disease, Chronic Obstructive · IRCCS Azienda Ospedaliero-Universitaria di Bologna.

Planned enrollment
4th of 10
31 · median 21
Started
2024
the only one that year
No phase
5 of 12
2 open now
Registered
9th of 12
by date

Among the 12 studies in Pulmonary Disease, Chronic Obstructive by IRCCS Azienda Ospedaliero-Universitaria di Bologna, this one is the 4th largest by planned enrollment of the 10 interventional ones, is the only one that started in 2024, is one of 5 with no phase, and was the 9th registered.

By phase

12 studies; the count open now beside each. This study's row is marked.

No phasethis study5 · 2 open
Phase 45 · 0 open
Observational2 · 2 open

By the year they started

First in 2004; this study’s year is marked. 1 started in 2024.

Size and results

Median enrollment 21 across the 10 interventional studies, 163 across the 2 observational. Of the 6 that completed or were terminated, 0 (0%) have results posted.

Watch this landscapeDownload CSVWith an account: a weekly mail of what changed among 12 studies in Pulmonary Disease, Chronic Obstructive by IRCCS Azienda Ospedaliero-Universitaria di Bologna, or all of them as a file.
02

Study summary

This multicenter, cross-over study aims to investigate the effects of two different respiratory strategies, the use of high flow nasal cannula (NHF) and the use of home mechanic ventilation (HMV), both associated with standard oxygen therapy, in patients with COPD and persistent hypercapnia following a severe acute exacerbation.

The purpose is to evaluate whether the clinical benefits, in terms of reduction in PaCO2 levels, resulting from the use of NHF are non-inferior to those obtained from the use of HMV.

Partecipants will be randomized at 1:1 ratio into two groups:

group 1: will start the respiratory strategy under study (NHF + standard oxygen therapy) as first treatment group 2 will start the control respiratory strategy (HMV + standard oxygen therapy) as first treatment.

The study has a crossover design: each patient will undergo treatment with the two different respiratory strategies, NHF and HMV, each lasting for 3 months

Read the detailed description

This multicenter, cross-over study aims to investigate the effects of two different respiratory strategies, the use of high flow nasal cannula (NHF) and the use of home mechanic ventilation (HMV) both associated with standard oxygen therapy, in patients with COPD and persistent hypercapnia following a severe acute exacerbation. The purpose of this study is to evaluate whether the clinical benefits, in terms of reduction in PaCO2 levels, resulting from the use of NHF are non-inferior to those obtained from the use of HMV.

Patients will be randomly assigned through a simple randomization list, stratified by recruiting center, generated by the Stata statistical software. Based on this list, patients will be divided into two groups: group 1 will start as the first treatment with the respiratory strategy under study (NHF + standard oxygen therapy) and group 2 will start as the first treatment with the control respiratory strategy (HMV + standard oxygen therapy). Randomization will occur at a 1:1 ratio. The study has a crossover design; each patient will undergo treatment with the two different respiratory strategies, NHF and HMV, each lasting for 3 months. To minimize the carry-over effect, a washout period of 7 days between respiratory supports will be scheduled. Therefore, considering the washout period, the total treatment duration is 25 weeks.

03

Conditions studied

  • COPD
  • Hypercapnia
  • Exacerbation Copd

Keywords

  • COPD
  • hypercapnia
  • NHF
  • HMV
  • PaCO2
04

Who can participate

Ages eligible
18 Years to 90 Years
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Age ≥18 years
  • Acquisition of form
  • Patients with
  • Persistent hypercapnia (PaCO2 >53 mmHg) 2-4 weeks after an acute hypercapnic exacerbation of COPD requiring NIV.
  • pH value >7.35.
  • Chronic hypoxemia (PaO2 \<55mmHg or \<60mmHg if at least one of the following criteria is present: polycythemia, pulmonary hypertension or Chronic Pulmonary Heart Disease, >30% of sleep time with SpO2 \< 90% measured with a pulse oximeter)

Exclusion criteria

Exclusion Criteria:

  • >30 kg/m2
  • obstructive sleep apnea syndrome (patients in whom there was a clinical suspicion of OSA syndrome based on clinical review or overnight oximetry will go further testing with limited respiratory polygraphy)
  • Neuromuscular or chest wall diseases
  • Need for intubation and invasive mechanical ventilation during exacerbation
  • Use of home non-invasive mechanical ventilation or CPAP
  • for NIV
  • Presence of cognitive impairment that would prevent into the trial
  • Patients with active and unstable coronary artery syndrome
  • Patients suffering from
Terms in these criteria, in plain language(6)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

COPD

Chronic obstructive pulmonary disease: long-term lung disease that makes it hard to breathe out, including emphysema and chronic bronchitis.

BMI (body mass index)

Weight in kilograms divided by height in metres squared. Example: 70 kg and 1.75 m gives 70 ÷ (1.75 × 1.75) ≈ 22.9.

What counts as overweight or obesity differs between countries (some use lower cut-offs), so go by the range the study states.

Clinically significant

Judged by the study doctor to matter for your health or for the study. It is a doctor’s decision, so ask the study team if you are unsure whether something counts.

Contraindication

A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

05

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Crossover assignment
Masking
None (open label)
Enrollment
31 participants (estimated)

Study arms

  • Experimental
    Group 1

    NHF/LTOT

    Device: Group 1: NHF/LTOT

  • Active comparator
    Group 2

    HMV/LTOT

    Device: Group 2: HMV/LTOT

Interventions

  • DeviceGroup 1: NHF/LTOT

    Patients assigned to this group will start NHF (Nasal High Flow) + oxygen therapy at home and undergo a preliminary trial with NHF to set the optimal flow using the MyAIRVO 3 (Fisher \& Paykel Healthcare, Auckland, New Zealand) with Optiflow+Duet interface. Patients assigned to this group will be required to use NHF for a minimum of 6 hours per night during sleep, while no restrictions will be set on the duration of use or the times of day to use the device. Patients will continue this treatment for a period of 3 months. At the end of the 3 months, there will be a one-week wash-out period, after which treatment with the control respiratory strategy (HMV+LTOT) will begin.

  • DeviceGroup 2: HMV/LTOT

    Patients assigned to this group will start home treatment with HMV (Home Mechanical Ventilation) + oxygen therapy and will be treated with HMV using a pressure support (PS) ventilator. HMV will be administered via nasal mask or full face mask according to patients' preference. Patients assigned to this group will be required to use HMV for a minimum of 6 hours per night in addition to daily home oxygen therapy for at least 15 hours. Moreover, no restrictions will be imposed on the duration of use or the times of day to use the device. Patients will continue this treatment for a period of 3 months. At the end of the 3 months, there will be a one-week wash-out period, after which treatment with the studied respiratory strategy (NHF+LTOT) will begin.

06

What researchers measure

Primary outcomes

  1. Evaluation of the non-inferiority of the change in PaCO2 levels measured during treatment with NHF respiratory support compared to HMV respiratory support, both associated with standard oxygen therapy.

    Unity of measurement: mmHg

    Time frame: T0 (baseline), T1 (+3months), T2 (+6months)

Secondary outcomes

  1. Evaluation of the time required for setting up and adjusting the two respiratory strategies.

    Unit of measurement: days

    Time frame: T0 (baseline), T1 (+3months), T2 (+6months)

  2. Evaluation of PaO2 levels measured via arterial blood gas analysis

    Unit of measurement: mmHg

    Time frame: T0 (baseline), T1 (+3months), T2 (+6months)

  3. FVC, FEV1

    Measured by spirometry Unit of measurement for FVC and FEV1: L

    Time frame: T0 (baseline), T1 (+3months), T2 (+6months)

  4. Evaluation of exercise capacity measured using the 6-minute walk test (6MWT)

    Unit of measurement: meters

    Time frame: T0 (baseline), T1 (+3months), T2 (+6months)

  5. Evaluation of dyspnea measured using the Medical Research Council Dyspnea score

    mMRC score ranges from 0 to 4. 0=No dyspnea symptoms 4=severe dyspnea

    Time frame: aT0 (baseline), T1 (+3months), T2 (+6months)

  6. Evaluation of quality of life measured using the St. George's Respiratory Questionnaire

    SGRQ's Total Score ranges between 0 and 100, where 0 is maximum quality of life and 100 is lowest quality of life

    Time frame: T0 (baseline), T1 (+3months), T2 (+6months)

  7. Evaluation of quality of sleep measured using the Pittsburg Sleep Quality Index

    PSQI ranges from 0 to 21, higher score indicate worse sleep quality

    Time frame: T0 (baseline), T1 (+3months), T2 (+6months)

  8. Evaluation of compliance to respiratory supports measured by downloading usage data from the respiratory support.

    Time of usage of the respiratory support in hours/day and hours/night.

    Time frame: T1 (+3months), T2 (+6months)

  9. Evaluation of tolerance to respiratory supports meauserd using visual analog scales

    Visual analog scale ranges between 0 to 10, 0=minimum tolerance 10=maximum tolerance

    Time frame: T1 (+3months), T2 (+6months)

  10. Evaluation of frequency of exacerbations measured by counting the numbers of exacerbations occurred.

    Unit of measurement: number of events

    Time frame: three, six and 12 month since the beginning of the treatment

  11. Evaluation of severity of exacerbations and subsequent hospitalizations measured by counting the number of exacerbations that required hospitalizations

    Unity of measurement: number of exacerbation that required hospitalisation

    Time frame: T1 (+3months), T2 (+6months) and T3 (+12months)

  12. Evaluation of survival measured by mortality analysis

    Time frame: T1 (+3months), T2 (+6months) and T3 (+12 months)

07

Study locations

5 of 5 sites recruiting
  • Ospedale S Donato
    Arezzo, Italy
    Recruiting
    • Raffaele Scala · Contact
    • Raffaele Scala · Principal investigator
  • Bolzano Hospital
    Bolzano, Italy
    Recruiting
    • roberto dongilli · Contact
    • Roberto Dongilli · Principal investigator
  • Azienda Ospedaliera Universitaria Policlinico "G. Rodolico-Sn Marco"
    Catania, Italy
    Recruiting
    • Claudia Crimi · Contact
    • Claudia Crimi · Principal investigator
  • ICS Maugeri Spa Società Benefit IRCCS
    Pavia, Italy
    Recruiting
    • Annalisa Carlucci · Contact
  • Azienda Unità Sanitaria Locale
    Piacenza, Italy
    Recruiting
    • Cosimo Franco · Contact
    • Cosimo Franco · Principal investigator
08

References and documents

Publications

  • Murphy PB, Rehal S, Arbane G, Bourke S, Calverley PMA, Crook AM, Dowson L, Duffy N, Gibson GJ, Hughes PD, Hurst JR, Lewis KE, Mukherjee R, Nickol A, Oscroft N, Patout M, Pepperell J, Smith I, Stradling JR, Wedzicha JA, Polkey MI, Elliott MW, Hart N. Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation: A Randomized Clinical Trial. JAMA. 2017 Jun 6;317(21):2177-2186. doi: 10.1001/jama.2017.4451. PubMed 28528348 ↗
  • Ergan B, Oczkowski S, Rochwerg B, Carlucci A, Chatwin M, Clini E, Elliott M, Gonzalez-Bermejo J, Hart N, Lujan M, Nasilowski J, Nava S, Pepin JL, Pisani L, Storre JH, Wijkstra P, Tonia T, Boyd J, Scala R, Windisch W. European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD. Eur Respir J. 2019 Sep 28;54(3):1901003. doi: 10.1183/13993003.01003-2019. Print 2019 Sep. PubMed 31467119 ↗
  • Oczkowski S, Ergan B, Bos L, Chatwin M, Ferrer M, Gregoretti C, Heunks L, Frat JP, Longhini F, Nava S, Navalesi P, Ozsancak Ugurlu A, Pisani L, Renda T, Thille AW, Winck JC, Windisch W, Tonia T, Boyd J, Sotgiu G, Scala R. ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure. Eur Respir J. 2022 Apr 14;59(4):2101574. doi: 10.1183/13993003.01574-2021. Print 2022 Apr. PubMed 34649974 ↗
  • Storgaard LH, Hockey HU, Laursen BS, Weinreich UM. Long-term effects of oxygen-enriched high-flow nasal cannula treatment in COPD patients with chronic hypoxemic respiratory failure. Int J Chron Obstruct Pulmon Dis. 2018 Apr 16;13:1195-1205. doi: 10.2147/COPD.S159666. eCollection 2018. PubMed 29713153 ↗
  • Weinreich UM, Juhl KS, Soby Christophersen M, Gundestrup S, Hanifa MA, Jensen K, Andersen FD, Hilberg O, Storgaard LH. The Danish respiratory society guideline for long-term high flow nasal cannula treatment, with or without supplementary oxygen. Eur Clin Respir J. 2023 Feb 23;10(1):2178600. doi: 10.1080/20018525.2023.2178600. eCollection 2023. PubMed 36861118 ↗
  • Pisani L, Vega ML. Use of Nasal High Flow in Stable COPD: Rationale and Physiology. COPD. 2017 Jun;14(3):346-350. doi: 10.1080/15412555.2017.1315715. Epub 2017 May 1. PubMed 28459282 ↗

Individual participant data

Plan to share: No

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jul 15, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT07065799
Collaborators
Azienda Sanitaria dell'Alto Adige, Ospedale San Donato, Azienda Unita Sanitaria Locale di Piacenza, Policlinico Universitario, Catania, Fondazione Salvatore Maugeri
Responsible party
dr. Stefano Nava (Prof., IRCCS Azienda Ospedaliero-Universitaria di Bologna) — Principal investigator
First posted
Jul 15, 2025
Start date
Jun 30, 2024
Primary completion
Dec 2027 (estimated)
Completion
Jan 2028 (estimated)
Last update
Jul 15, 2025

Study contacts

Lara Pisani, Prof.ssa
Contact
lara.pisani@unibo.it
0512143257
Lara Pisani, Prof.ssa
principal investigator · University of Bologna

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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