Trial to evaluate feasibility and benefits of adding Nasal High Flow in a hospital in the home setting following acute hospital presentations for exacerbation of chronic obstructive pulmonary disease.

Consented patients with COPD exacerbations presenting to two tertiary level sites across a hospital network (Monash Medical Centre and Dandenong hospital) with be recruited within 24 hours of admission/medical stability and enrolled into the trial. . After a brief opportunity to trial Nasal High Flow (NHF), patients will be consented to ongoing periodic use of the NHF (AIRVO Fisher Paykel) with the expectation of discharge to the Hospital in the Home (HITH) program within 24 hours of consenting. NHF is a device that delivers high flow rates of humidified air or O2 up to a maximum of 60L/Min. NHF flushes the upper airway reducing effective anatomical deadspace, provides low levels of positive end expiratory pressure and humidifies the airway to improve mucociliary clearance. It is hypothesised this treatment will assist in early discharge and ongoing usage in the home setting will reduce readmission. NHF will be administered at 30L/min set at 37 degrees. The device does not deliver a preset pressure which will vary according to the patient up to 2-3cmH20. Supplemental O2 may be co-administered determined by the clinical care team. Care will continue at home for the remainder of their acute illness including daily periodic use of NHF for 30 days in the HITH setting. Compliance will be encouraged by daily visits for the first week and twice weekly thereafter by qualified nursing staff familiar with NHF. Compliance will be recorded from device monitor. Patients will receive bronchodilators, oral corticosteroids, antibiotics and where indicated supplemental O2 as part of their routine care prescribed by their inpatient care team. In addition patients will be maintained on NHF as much as is tolerable with minimum usage of 6 hours per day for 30 days. Patients will be encouraged to use the device overnight to achieve target usage. As this is a feasibility trial outcomes will be compared to matched historic controls.