Abstract
SESSION TITLE: COPD 3 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Long Term Oxygen Therapy (LTOT) for patients with chronic obstructive pulmonary disease (COPD) has long been a mainstay of treatment for patients with advanced COPD, regardless of whether a patient is an active smoker. Within the Veterans Affairs systems, extensive counseling is provided to patients who remain active smokers while on LTOT to prevent adverse events like fires and resultant burns. Nonetheless, fire incidents related to LTOT have been reported. We therefore conducted a study of veterans with COPD who were initiated on LTOT at the Central Texas Veterans Health Care System and the incidence of fire-related events during the study period. METHODS: We conducted a retrospective chart review of all veterans who were prescribed new LTOT between October 2010 and September 2015. Inclusion criteria were all veterans who had a confirmed diagnosis of COPD by spirometry and who met criteria for either continuous oxygen therapy or oxygen therapy with ambulation and sleep and did not have hypoxemia as a result of diseases other than COPD. Of the 158 patients who met the criteria to be included in the study, 152 were male. Due to the small sample of females, analysis was conducted on the male cohort only. Firth’s bias reduction method was used to model the outcome variable fire-related incident with following predictors: smoking status, age, race, depression, PTSD, and type of oxygen used. RESULTS: Of 152 patients in the study, 50 were actively smoking on LTOT. In total, nine veterans had fire-related incidents during the study period. All nine patients, or 17% of the study population, were actively smoking at the time fire incidents. There were no deaths related to fire incidents. Five patients required hospitalization due to facial burns resulting from fire-related incidents. The odds of a fire-related incident occurring in a smoker were 43.5 (5.02 - 5721) times the odds of a fire related incident occurring in a non-smoker (p<0.001). None of the other predictors in the model were associated with fire-related incidents. CONCLUSIONS: Our study demonstrates high incidence of fires related to LTOT in veterans who continue to smoke. Fire incidents occurred exclusively in those who were active smokers with no other predictors of fire incidence. CLINICAL IMPLICATIONS: Traditional indications for LTOT are coming under scrutiny after the Long Term Oxygen Treatment Trial recently published in the New England Journal of Medicine found no benefit with respect to time to death or first hospitalization among patients with stable COPD and resting or exercise-induced moderate desaturation. According to the National Ethics Committee of the Veterans Health Administration, LTOT should be offered to veterans who opt to continue to smoke despite education during initiation of home oxygen. Termination of LTOT should only occur in extreme cases after all relevant harm reduction techniques have failed. Despite following these recommendations, extensive harm reduction techniques and close follow up, we found there is a high incidence of fires in veterans with COPD on LTOT who continue to smoke. The probable cost of fire-related incidents along with the physical risks begs re-examination of prescribing home oxygen to those who continue to smoke. DISCLOSURE: The following authors have nothing to disclose: Tasnim Lat, Pawan Sikka, Rachael Pattison, John Coppin, Badri Giri, Udaya Bhat No Product/Research Disclosure Information
Published Version
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