Abstract
The need for oxygen increases with activity in patients with COPD and on long-term oxygen treatment (LTOT), leading to periods of hypoxemia, which may influence the patient’s performance. This study aimed to evaluate the effect of automated oxygen titration compared to usual fixed-dose oxygen treatment during walking on dyspnea and endurance in patients with COPD and on LTOT. In a double-blinded randomised crossover trial, 33 patients were assigned to use either automated oxygen titration or the usual fixed-dose in a random order in two walking tests. A closed-loop device, O2matic delivered a variable oxygen dose set with a target saturation of 90–94%. The patients had a home oxygen flow of (mean ± SD) 1.6 ± 0.9 L/min. At the last corresponding isotime in the endurance shuttle walk test, the patients reported dyspnea equal to median (IQR) 4 (3–6) when using automated oxygen titration and 8 (5–9) when using fixed doses, p < 0.001. The patients walked 10.9 (6.5–14.9) min with automated oxygen compared to 5.5 (3.3–7.9) min with fixed-dose, p < 0.001. Walking with automated oxygen titration had a statistically significant and clinically important effect on dyspnea. Furthermore, the patients walked for a 98% longer time when hypoxemia was reduced with a more well-matched, personalised oxygen treatment.
Highlights
Dyspnea is the most debilitating symptom experienced by patients with Chronic Obstructive Pulmonary Disease (COPD) [1]
The oxygen requirement increases during exercise, so even though the patients receive the amount of oxygen required at rest, they still desaturate during activity, and are thereby limited by hypoxemia and dyspnea [5]
No harms were registered during or after the tests. In this randomised crossover study, firstly, we found that walking with automated oxygen titration had a statistically significant and clinically important effect on dyspnea in patients with advanced COPD on long-term oxygen treatment (LTOT)
Summary
Dyspnea is the most debilitating symptom experienced by patients with Chronic Obstructive Pulmonary Disease (COPD) [1]. Patients with advanced COPD often develop respiratory failure with chronic hypoxemia and the need for long-term oxygen treatment (LTOT) [1,3]. LTOT, which improves pulmonary hemodynamics and survival, is recommended for 15–24 h a day and the given oxygen flow rate should maintain the partial pressure of oxygen (PaO2 ) > 8 kPa at rest [3,4]. The oxygen requirement increases during exercise, so even though the patients receive the amount of oxygen required at rest, they still desaturate during activity, and are thereby limited by hypoxemia and dyspnea [5].
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