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This pilot, prospective single-center randomized placebo-controlled trial assessed nocturnal HHHFA in COPD with chronic bronchitis and evaluated sleep quality, dyspnea, quality of life, cough, lung function, imaging, and exercise capacity at baseline and 6 weeks. Seven of 11 participants completed, and no statistically significant differences emerged between groups in primary or secondary outcomes. 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Hoffman , 1,3,4 and Alejandro P. Comellas 1  \n1Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA 2Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA 3Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA  \n4Department of Radiology, University of Iowa, Iowa City, Iowa, USA  \nCorrespondence should be addressed to Spyridon Fortis; [spyridon-fortis@uiowa.edu](spyridon-fortis@uiowa.edu)  \nReceived 24 September 2025; Revised 9 November 2025; Accepted 4 December 2025  \nAcademic Editor: Nidhi Chaudhary  \nCopyright © 2025 Spyridon Fortis et al. Pulmonary Medicine published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \nIntroduction: Heated, humidified high-flow air (HHHFA) has been shown to reduce exacerbations in patients with COPD or bronchiectasis with significant sputum production. This pilot study evaluated the short-term effects of nocturnal HHHFA in COPD patients with chronic bronchitis.  \nMethods: This was a prospective, single-center, open-label, randomized, placebo-controlled trial. Participants with COPD, chronic bronchitis, and ≥ 2 exacerbations in the prior year were randomized to either nocturnal HHHFA or usual care. Assessments included sleep quality, dyspnea, quality of life, cough, lung function, imaging, and exercise capacity at baseline and 6 weeks.  \nResults: Of 11 eligible participants, seven completed the study (four intervention, three control) . Baseline characteristics were generally similar, though the intervention group had a higher BMI and a lower emphysema percentage. No statistically significant differences were observed between groups in primary or secondary outcomes.  \nConclusions: Nocturnal HHHFA over 6 weeks did not improve clinical or imaging outcomes in this small cohort of COPD patients with chronic bronchitis. The study was likely underpowered due to recruitment challenges. Larger trials are needed to assess the potential of HHHFA in this population.  \nTrial Registration: ClinicalTrials.gov identifier: NCT03959982  \nKeywords: chronic obstructive; death; disease progression; emphysema; pulmonary disease; smoking  \n1. Introduction  \nChronic obstructive pulmonary disease (COPD) is marked by exacerbations that increase in frequency with disease severity and often lead to hospitalizations—the primary driver of COPD-related healthcare costs and a major burden for patients and families [1] . Chronic bronchitis, defined by persistent cough and sputum production for at least 3 months in 2 consecutive years, doubles the risk of exacerbations and hospitalizations [2] . It is also linked to worse dyspnea, reduced quality of life and sleep, and impaired exercise  \ncapacity due to air trapping and hyperinflation [2] . Despite its impact, treatment options beyond standard inhaled therapies remain limited.  \nHeated, humidified high-flow air (HHHFA) has been shown to reduce exacerbations in patients with COPD or bronchiectasis with significant sputum production [3] . This pilot study evaluates the effect of nocturnal HHHFA in COPD patients with chronic bronchitis, focusing on shortterm outcomes including respiratory symptoms, quality of life, sleep, lung function, imaging features, and exercise capacity.  \n2 Pulmonary Medicine  \nTABLE 1: Baseline characteristics.  \n\n|  | Control | HHHFA | p value |\n| --- | --- | --- | --- |\n| n | 3 | 4 |  |\n| Age | 61.00 [57.50, 70.00] | 58.00 [56.50, 63.00] | 0","cbCais6E44QX03kw","https://ap.wps.com/l/cbCais6E44QX03kw","pdf",730989,"English","# Introduction\n# Methods\n# Results\n# Conclusions\n# Trial Registration\n## Table 1: Baseline characteristics","[{\"question\":\"What outcomes and assessments were included in the study?\",\"answer\":\"Assessments included sleep quality, dyspnea, quality of life, cough measures, lung function, imaging, and exercise capacity, along with baseline and 6-week follow-up measurements.\"}]","The Effect of Heated, Humidified High-Flow Air in COPD Patients With Chronic Bronchitis | PDF",1790690011,13]