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Background We initiate home high-flow therapy (HFT) on case-case basis for patients with COPD who have severe dypsnoea, recurrent exacerbations or emerging hypercapnic respiratory failure (not requiring or not tolerating home NIV) despite optimised management. Remote monitoring including patient-reported outcomes (PROs), clinical events, asynchronous messaging and device usage has been incorporated using our COPD digital service and connected LumisHFT devices (Airview platform, ResMed) to support therapy provision and clinician workflow.Methods A retrospective electronic health record (EHR) and remote-monitoring data review was conducted for 58 COPD patients who commenced home HFT between 2018–2024, with data censored February 2025.Results Annual respiratory-related hospital admissions decreased by one per patient, with a reduction of 14 occupied bed days per patient per year in the subgroup of patients who used home HFT. Median time to readmission or death was 21 weeks in non-users and 52 weeks in HFT users. Exploration of remote-monitoring insights at a per patient level noted improvement in PROs (CAT score, EQ5D5L) and reduction in antibiotic and prednisolone courses following HFT initiation. Patients typically used HFT more frequently during the early adoption phase, and reduced their usage as their condition improves.Conclusion Reduction in healthcare resource utilisation in this observational cohort adds to the evidence-base for home HFT as a valuable intervention for selected patients with COPD. Remote monitoring insights can enrich our understanding of patient and service benefits, and support adoption of this respiratory support modality.