Initial Public Offering

Initial Public OfferingNOVEMBER 2018

Safe Harbor StatementCertain statements in this presentation, including responses to questions, contain or may contain “forward-looking statements” within the meaning of the PrivateSecurities Litigation Reform Act of 1995. All statements other than statements of historical facts contained in this presentation are forward-looking statements. Insome cases, you can identify forward-looking statements by terms such as “may,” “will,” “should,” “expect,” “plan,” “anticipate,” “could,”’ “intend,” “target,”“project,” “contemplate,” “believe,” “estimate,” “predict,” “potential” or “continue” or the negative of these terms or other similar expressions, although not allforward-looking statements contain these words. Forward-looking statements include, but are not limited to, statements concerning: estimates regarding theannual total addressable global market for our Precision Flow systems, future results of operations, financial position, research and development costs, capitalrequirements and our needs for additional financing; commercial success and market acceptance of our Precision Flow systems; competitive companies andtechnologies in our industry; our ability to enhance our Precision Flow systems, expand our indications and develop and commercialize additional products; ourbusiness model and strategic plans for our products, technologies and business, including our implementation thereof; our ability to accurately forecast customerdemand for our Precision Flow systems and manage our inventory; our ability to expand, manage and maintain our direct sales and marketing organization, and todistribute our Precision Flow systems in markets outside of the United States; our ability to hire and retain our senior management and other highly qualifiedpersonnel; our ability to obtain additional financing in the offering to which this presentation relates or future offerings; our ability to commercialize or obtainregulatory approvals for our products, or the effect of delays in commercializing or obtaining regulatory approvals; FDA or other U.S. or foreign regulatory actionsaffecting us or the healthcare industry generally, including healthcare reform measures in the United States and international markets; the timing or likelihood ofregulatory filings and approvals; our ability to establish and maintain intellectual property protection for our products or avoid claims of infringement; the volatilityof the trading price of our common stock; our expectations regarding the use of proceeds from the offering to which this presentation relates; our expectationsabout market trends; and the other risks described in the “Risk Factors” section in the Company’s Registration Statement on Form S-1, declared effective by theSecurities Exchange Commission on November 13, 2018, and the Company’s other filings with the Securities Exchange Commission.The forward-looking statements in this presentation are only predictions and are based largely on our current expectations and projections about future events andfinancial trends that we believe may affect our business, financial condition and results of operations. These forward-looking statements speak only as of the date ofthis presentation and are subject to a number of known and unknown risks, uncertainties and assumptions. Because forward-looking statements are inherentlysubject to risks and uncertainties, some of which cannot be predicted or quantified and some of which are beyond our control, you should not rely on theseforward-looking statements as predictions of future events. The events and circumstances reflected in our forward-looking statements may not be achieved oroccur, and actual results could differ materially from those projected in the forward-looking statements. Moreover, we operate in an evolving environment. Newrisk factors and uncertainties may emerge from time to time, and it is not possible for management to predict all risk factors and uncertainties. Except as requiredby applicable law, we do not plan to publicly update or revise any forward-looking statements contained herein, whether as a result of any new information, futureevents, changed circumstances or otherwise.[ 2 ]

A global medical technologycompany focused on treatingpatients with respiratory distressProprietaryHi-VNI TechnologyThe only mask-free, clinically validated alternative tocurrent standard of care for the treatment ofrespiratory distressClinicallyOver 1.5MOver 13KValidatedPatients TreatedInstalled Base[ 3 ]* LTM 9/30/18 41MRevenues*24% YoY Growth

Severe Difficulty Breathing –Can’t inhale enough O2or clear enough CO2THE CAUSESPneumoniaHeart failureA LargeandGrowingMarketAffects All Ages– pre-term infants, children,adultsTHE DRIVERSAging populationAsthmaGrowing prevalence ofheart failureCOPDGrowing prevalence of COPD and many other diseases[ 4 ]RespiratoryDistress –

1.5 Billion Global Market –in Current Products, in Current Care Areas AloneCURRENT CARE SETTINGSHOSPITAL DIRECTORYEmergency DepartmentIntensive Care (ICU)Long Term Acute CareNeonatal (ICU)CURRENT ADDRESSABLE MARKETSSelect Ex-US2USPediatric (ICU)12M1patients sufferingrespiratory distress12Combined over 1.5BNSuffering from respiratory distress in the US and select international markets who can benefit from Vapotherm technologyUK, Germany, Brazil, Mexico, Japan, and select markets[ 5 ]

Traditional Treatment ModalitiesHave LimitationsLIMITATIONS O2 delivery only Clinically unproven inpatients with elevated CO2 30% patients do not tolerate High intensity of care Risks: skin breakdown, lunginjury, etc.INVASIVENESSMechanical Ventilationof ModalityNIPPV(Non-Invasive PositivePressure Ventilation)Oxygen-BasedTherapiesTRADITIONAL STANDARDOF CARE35 year-old TechnologyACUITY of Respiratory Distress[ 6 ] Sedation often required Increases clinical risk and cost Difficulty weaning

NIPPV:Challenging for Many Patients and CliniciansTIGHT-FITTING MASK Can’t eat / drink / communicate Uncomfortable / claustrophobic Side effects: skin ulcers / risk ofvomiting / aspirationESCALATION THERAPY Start at low pressure,increase as tolerateduntil patient stabilizesPRESSURE VENTILATION Must time their breathingALTHOUGH EFFICACIOUS:POORLY Tolerated VARIABLE Administration FREQUENT Patient Monitoring[ 7 ]

On the Front Lines:Care Giver Experience with NIPPVINTERVIEWS WITH CRITICAL CARE NURSES AT THE 2018 NATIONAL TEACHINGINSTITUTE & CRITICAL CARE EXPOSITIONQHow many of your patients,approximately, experience somesort of anxiety when you’reapplying a BiPAP or CPAP mask?“““Not going to say100%.but at least 80%.20-30% I would say atleast they just getagitated.Almost all of them a lot of our patients feelclaustrophobic withthe masks.QHow do you deal with that?What happens to those?““Some of them we negotiate anddo the off for a while, on for awhile. Some of them we haveto do medication to make themcalm. Sometimes somebodyhas to sit with them.We give them medications, anxietymedications; Ativan, Valium, andsometimes it progresses to moreaggressive treatment, you know,having to be intubated and thingslike that.* Each of these statements is an expression of opinion of the individual making the statement and not of the Company and is not intended to berepresentative of all cases. You should not rely on any of these statements, individually or in combination, when making an investment decision.[ 8 ]

Hi-VNI Technology:Attractive Alternative to NIPPVNON-OCCLUSIVENASAL CANULA No mask-fitting required Easy to eat / drink / talk Better tolerated andmore comfortableDE-ESCALATION THERAPYNO POSITIVE PRESSURE Appropriate to startat high flows Decreases risk of softtissue damageClinically validated to be AS EFFICACIOUS AS NIPPV for spontaneously breathing patients AND:BETTER Tolerated EASIER Administration REDUCED Patient Monitoring Potential[ 9 ]

Hi-VNI Technology Redefines the Continuumof Care for Respiratory DistressIncreased Acuity Levels of Respiratory I Technology by VapothermMechanical VentilationHigh velocity nasal insufflation of oxygen is easier to set up than NIPPV. Should thisstudy’s findings be replicated in larger studies, Hi-VNI might replace NIPPV in EDs,intensive care units, and ambulances.– Feb 2018[ 10 ]Mechanical ��

Hi-VNI Technology:Breakthrough Solution to Help Avoid IntubationCO2-richdeadspaceDelivers conditionedbreathing gas topatientFlushes CO2 from respiratorydead space between breathsOUR SECRET SAUCE[ 11 ]High VELOCITYProper HUMIDIFICATION in an open system delivers adequately conditioned oxygen

Delivering Velocity and Humidificationwith Hi-VNI TechnologyHigh VELOCITYProper HUMIDIFICATION70Hi-VNI TechnologyVelocity (m/sec)6050Driven gas stream40ConventionalHigh Flow Oxygen30Water vapordiffuses throughthe membraneinto gas stream20100020406080Volumetric Flow (L/min) creates efficient flush –even in patients breathing rapidly[ 12 ]Gas saturated withvapor at bodytemperature ofcirculating water allows patient comfort and abilityto tolerate therapy

Our Connected, Mobile, AdaptablePrecision Flow SystemsCapital UnitPRECISION FLOW PLUSDisposablesPATIENT CIRCUITDELIVERY TUBEWarm waterBreathing GasWarm waterBreathing GasFlowReturnCross-Section of TubingVapothermTransfer Unit[ 13 ]Electronic Components;Input Gas ControlsBreathing GasTriple-lumen Delivery TubeSmall-bore Nasal Interfacesand Adapters

Broad Use Today Across Care Areas and Care GiversPhysiciansHOSPITAL DIRECTORYRespiratoryTherapistsEmergency DepartmentIntensive Care (ICU)Long Term Acute CareNeonatal (ICU)Pediatric (ICU)NursesUS OPPORTUNITY& CURRENTPENETRATION (inblue):GROWTHFOCUS[ 14 ]5,000EDsEmergency departments400LTACHsNew hospital departments1,100NICUsNew areaspre- and post-hospital

Compelling Clinical DataINTUBATION RATESHi-VNI TECHNOLOGY vs. NIPPVBLOOD CARBON DIOXIDE LEVELSOVER TIME% Intubated in 72 Hours70NIPPVHi-VNITechnology7%Non-inferiorto NIPPV inpreventingintubation13%NIPPVPCO2 (mmHg)6050Hi-VNI Technology4030Similar decrease in bloodCO2 levels201005101520250BL1 Hr4 HrSample TimepointA 204-patient, multi-site prospective randomized controlled trial showed Hi-VNIis a safe and effective alternative to NIPPV for all cause respiratory distress patients[ 15 ]

Expanded FDA Indications for UseAPRIL 2018De novo Grant for Expanded Indication for Use withUpdated Version of Precision Flow SystemsCreated new category and expanded indication for use:The updated version of our system is the ONLY product listedWe believe validates clinical differentiation and value proposition,establishing Hi-VNI as attractive alternative to NIPPV[ 16 ]

Improved Patient Experience withReduced Cost of CareHOSPITAL DIRECTORYEmergency DepartmentIntensive Care (ICU)Long Term Acute CareGeneral Care FloorEmergency Department Impact(One Patient; Two Visits) 1 4,500 3,750savings 750ICU3 days(Intubated)1.A single-patient case study report from Athens Regional Medical Center[ 17 ]General Care Floor1 day(Hi-VNI Technology)

Clinically-Focused Sales ApproachSALES ORS100 personsales organizationGermany, UK, Brazil,Japan, Mexico[ 18 ]DIRECTSALESDigital MarketingMedical EducationExistingCustomersCLINICALEDUCATION

Pipeline of New ProductsNext Generation Hi-VNITechnology ProductUpdated PrecisionFlow Systems Updating electronics tocomply with new regulatoryrequirements in Europe Updating software to meetrequirements of de novo grant[ 19 ]Modules to simplify andautomate adjustments toPrecision Flow systems’delivery of oxygenatedbreathing gas Recently completed clinicaltrials in pre-term infants Provide high-velocity nasalinsufflation using a portabledevice, removing requirementfor access to built-in walloutlets that providecompressed airEnhanceMarket-ExpandingCurrent PortfolioProducts

We Hire,Developand RetainTalentedPeople inthe MedicalIndustry[ 20 ]