Long-term Domiciliary Oxygen Therapy Research Articles

Idiopathic pulmonary fibrosis in Soweto, South Africa: A descriptive study

Objectives: Idiopathic pulmonary fibrosis (IPF) is a specific form of age-related fibroproliferative interstitial pneumonia that is chronic, progressive, and carries a poor prognosis, with median survival of just 2.5–3.5 years from diagnosis. The exact etiology is unknown, but smoking is known to be risk factor. Symptoms and signs include progressive dyspnoea, cough, inspiratory “Velcro” crackles, and clubbing. At present, treatment options are limited; but include pulmonary rehabilitation, long-term domiciliary oxygen therapy, and the conditionally recommended pharmacological therapies pirfenidone and nintedanib. This study sought to describe the cohort of patients that attended the respiratory outpatient services at a tertiary-level hospital in South Africa during the period 2007– 2016. To the best of the authors’ knowledge, this is the first such descriptive study performed in Africa. Materials and Methods: This was a retrospective, descriptive, and record review, that included patients ≥18 years of age who fulfilled 2011 ATS/ERS/JRS/ALAT diagnostic criteria for IPF. Results: Data from 74 patients were used for analysis in this study, of which 60.8% were female. The mean age standard deviation was 64.4 (10.9) years and the majority (79.7%) were Black. Over half of the patients (40/74, 54.1%) were current or previous smokers, although there was no correlation between smoking history and age or baseline pulmonary function testing. All patients reported dyspnea, which was modified Medical Reseach Council (mMRC) Grade 3 or 4 in 80% of patients. High resolution computed tomography chest was reported as radiological usual interstitial pneumonia (UIP) in 72 patients (97.3%) and three patients underwent lung biopsy, all of which showed a UIP pattern. Fifty-eight patients (78.4%) had spirometry results available, with median forced vital capacity 67.3% of predicted; this was significantly higher in females. Median transfer factor of the lung for carbon monoxide was 39% predicted. Twenty-five patients (33.8%) received corticosteroids, of whom five (6.8%) received the prednisone-azathioprine-N-acetylcysteine regime. Three patients (4.1%) received nintedanib; two of whom showed slowing of decline in lung function, although no significant symptomatic improvement was reported. Mean duration of follow-up was 13.3 months, although females had significantly longer duration of follow-up than males. Conclusion: Despite a fairly small sample size and retrospective nature, this study contributes to the body of literature on IPF and highlights the need for additional studies in developing countries, particularly in Africa.

One-year Mortality in COPD After an Exacerbation: The Effect of Physical Activity Changes During the Event

ABSTRACTMortality is one of the most important outcomes in patients with chronic obstructive pulmonary disease (COPD). Different predictors have been associated with mortality, including the patient's level of physical activity (PA). The objective of this work was to establish the relationship between changes in PA during a moderate-to-severe COPD exacerbation (eCOPD) and 1-year mortality after the index event. This was a prospective observational cohort study with recruitment of 2,484 patients with an eCOPD attending the emergency department (ED) of 16 participating hospitals. Variables recorded included clinical and sociodemographic data from medical records, dyspnea, health-related quality of life, and PA before the index eCOPD and 2 months after the hospital or ED discharge, as reported by the patient. In the multivariate analysis worsening changes in PA from baseline to 2 months after the ED index visit [odds ratio (ORs) from 2.78 to 6.31] was related to 1-year mortality, using the age-adjusted Charlson comorbidity index (OR: 1.22), and previous use of long-term domiciliary oxygen therapy or non-invasive mechanical ventilation at home (OR: 1.68). The same variables were also predictive in the validation sample. Areas under the receiver operating characteristic curve in the derivation and validation sample were 0.79 and 0.78, respectively. In conclusion, PA is the strongest predictor of dying in the following year, i.e., those with worsened PA from baseline to 2 months after an eCOPD or with very low PA levels have a higher risk.

Oxygen With Cold Bubble Humidification Is No Better Than Dry Oxygen in Preventing Mucus Dehydration, Decreased Mucociliary Clearance, and Decline in Pulmonary Function

Little is known about the effects of long-term nasal low-flow oxygen (NLFO) on mucus and symptoms and how this variable is affected by dry or cold humidified gas. The aim of this study was to investigate the effects of dry-NLFO and cold bubble humidified-NLFO on nasal mucociliary clearance (MCC), mucus properties, inflammation, and symptoms in subjects with chronic hypoxemia requiring long-term domiciliary oxygen therapy. Eighteen subjects (mean age, 68 years; 7 male; 66%with COPD) initiating NLFO were randomized to receive dry-NLFO (n= 10) or humidified-NLFO (n= 8). Subjects were assessed at baseline, 12 h, 7days, 30days, 12months, and 24months by measuring nasal MCC using the saccharin transit test, mucus contact angle (surface tension), inflammation (cells and cytokine concentration in nasal lavage), and symptoms according to the Sino-Nasal Outcome Test-20. Nasal MCC decreased significantly (40%longer saccharin transit times) and similarly in both groups over the study period. There was a significant association between impaired nasal MCC and decline in lung function. Nasal lavage revealed an increased proportion of macrophages, interleukin-8, and epidermal growth factor concentrations with decreased interleukin-10 during the study. No changes in the proportion of ciliated cells or contact angle were observed. Coughing and sleep symptoms decreased similarly in both groups. There were no outcome differences comparing dry vscold bubble humidified NLFO. In subjects receiving chronic NLFO, cold bubble humidification does not adequately humidify inspired oxygen to prevent deterioration of MCC, mucus hydration, and pulmonary function. The unheated bubble humidification performed no better than no humidification. ClinicalTrials.gov; No.: NCT02515786; URL: www.clinicaltrials.gov.

Living in the Wake of Chronic Obstructive Pulmonary Disease and Long-Term Oxygen Therapy

Background: Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the world. COPD is a progressive disease that could lead to chronic hypoxemia, which requires treatment as domiciliary Long-Term Oxygen Therapy (LTOT). There is a need for increased knowledge about self-care strategies used by individuals living with COPD and LTOT. Objective: The aim was to explore experiences and self-care strategies in patients living with both COPD and LTOT. Sample: The sample consisted of five men and five women diagnosed with COPD being prescribed LTOT for more than one year. Method: Ten interviews were undertaken and analyzed for both manifest and latent content. Results: Living with COPD and LTOT was associated with experiences of guilt although there were doubts about what had caused the lung disease. Both the lung disease and the oxygen therapy had a negative impact on their self-image. Anxiety was expressed when thoughts about the remaining time occurred. There was a constant balance between diminishing abilities and increasing restrictions related to the lung disease and the therapy. In order to compensate for arising imbalance, self-care strategies had been initiated aimed at preserving the present state of health, enabling and facilitating physical activity and promoting a positive attitude. Conclusion: The current study suggests that individuals living with COPD and LTOT are encouraged to adopt self-care strategies directed towards maintaining stability with regard to the lung disease, the oxygen therapy, physical capability and emotional reactions.

Stereotactic body radiotherapy for chronic obstructive pulmonary disease patients undergoing or eligible for long-term domiciliary oxygen therapy.

A major cause of death in patients undergoing long-term domiciliary oxygen therapy (LTOT) is lung cancer progression. In our institution, we actively perform stereotactic body radiotherapy (SBRT) on patients with early-stage non–small-cell lung cancer undergoing LTOT. In this study, we retrospectively analyzed the treatment efficacy and safety of SBRT for patients with T1-3N0M0 non–small-cell lung cancer who had been prescribed LTOT for treatment of chronic obstructive pulmonary disease (COPD). A total of 24 patients were studied. Their median age was 74 years (range, 63–87 years). The median duration from the start of LTOT to SBRT was 23 months (range, 0–85 months). Four of the 24 patients underwent lobectomy due to lung cancer. The median follow-up duration was 29 months (range, 5–79 months). One patient had a local recurrence. The median survival time was 30 months. The 3-year overall survival was 49%. In 6 of the 24 patients (25%), COPD presented with interstitial pneumonia. The 3-year overall survival for patients with COPD without interstitial pneumonia was significantly better than that for patients with both COPD and interstitial pneumonia (67% and 0%, respectively; P < 0.0001). Grade 5 radiation pneumonitis occurred in one patient (4%) with COPD with interstitial pneumonia. SBRT was tolerated by patients with early-stage non–small-cell lung cancer undergoing LTOT. SBRT should be considered for patients undergoing LTOT. However, clinicians should consider the risk of severe radiation pneumonitis in patients with interstitial pneumonia.

Community Physician-Guided Long-Term Domiciliary Oxygen Therapy Combined With Conventional Therapy in Stage IV COPD Patients.

The aim of the study was to explore clinical effect of community physician-guided long-term domiciliary oxygen therapy (LTDOT) on patients with Stage IV chronic obstructive pulmonary disease (COPD). A retrospective study. Fifty-four patients with Stage IV COPD were recruited and randomly divided into two groups (the LTDOT group and the control group). Patients in LTDOT group accepted additional oxygen therapy for more than 15 hours every day with continuous low flow (1-2 L/min) for 3 years. PaO2 (O2 pressure), FEV1/FVC (forced vital capacity), and FEV1% (percentage of forced expiratory volume in 1 second) in the LTDOT group increased significantly after treatment. A significant decrease was observed on the BODE index in the LTDOT group (p < .05) but not in control group (p > .05). Frequencies and costs of hospitalization therapy and emergency medical services were markedly decreased after 3 years of LTDOT. Community physician-guided LTDOT can improve prognosis and reduce the costs for stage IV COPD patients. Rehabilitation nurses can be instrumental in helping patients with stage IV COPD learn principles of LTDOT.

Perspective on long term oxygen therapy

The paper by Dal Negro et al.[1] raises a number of interesting issues. Patients with severe chronic obstructive pulmonary disease (COPD) were ranked according to hemoglobin in a program of monitored long term domiciliary oxygen therapy (LTOT). Good therapeutic compliance (mean 17 hours/24 hour day) using liquid oxygen at a flow rate of 2.3 L per minute, presumably through nasal cannulae, was achieved. This is remarkable: few schemes achieve such good adherence. Patients were mostly male, ex-smokers of mean age 71.4 years, of average body weight with few markedly over- or underweight. Blood hemoglobin ranged from moderately anaemic levels to frankly polycythemic. Anemic patients tended to be under weight raising the issues, as the authors discuss, of the consequences of systemic inflammatory disease, in some cases of advanced emphysematous COPD. The most interesting finding in this small study was the striking improvement not only in PaO2 but in PaCO2 with a trend to continuing benefit throughout the period. Similarly, hemoglobin crept in from the extreme limits to a normal middle range. Whilst it would not be surprising for polycythemia to redress, the idea that systemic inflammation might be reversible, indicated by a rising hemoglobin in response to LTOT in advanced COPD with emphysema, is notable. It is approaching 40 years since the original domiciliary oxygen therapy trials [2,3] were conducted in the UK and USA. It is worth comparing the type of patients enrolled in those trials with those treated today. In the UK, the mean age of the patients was in the early 50’s compared with over 70 years today. They suffered advanced COPD, were generally overweight, very edematous, polycythemic with hypoxemia and hypercapnia, the latter often severe. Hypercapnia limited the application of supplementary oxygen by its increase under oxygen administration. There was an increase in survival in the oxygen treated group through relief of extreme hypoxemia with no evidence to suggest attenuation or improvement of progressive COPD. The net result was an extension of life for two to three years. Since then, the natural history of COPD has changed. The time course of the pathological features has extended. Whilst death from COPD remains a major health issue, it is now a disorder predominantly of the over-70 years of age. Respiratory failure develops some 20–30 years later than it used to. Is it the same disease? There is now less extreme hypercapnia [4], obesity, edema, polycythemia but more underweight, extreme dyspnea, anemia and systemic markers of inflammation. It is still considered an inevitably progressive disorder for which current therapies provide amelioration rather than reversal of the destructive processes. This paper raises the question as to whether there is a therapeutic window during the now prolonged natural history to end-stage disease and death when therapeutic interventions such as well controlled LTOT might further attenuate outcome. This study is too small to reply to this question, but provides a challenge to the authors to engage in a much bigger, probably multi-center, study.

Estudio de la prevalencia y actitudes sobre tabaquismo en pacientes sometidos a oxigenoterapia crónica domiciliaria. Estudio toma

Introduction The objective of this study is to analyse the prevalence, attitudes and characteristics of smoking in the population of patients subjected to Long Term Domiciliary Oxygen Therapy (LTDOT) in the Community of Madrid. Patient and methods A representative sample of 845 subjects (of which 461 (46%) were male) was obtained from a total of 11,174 who fulfilled the inclusion criteria. The mean age was 78.25 years (95% Confidence Interval (CI): 77.55–78.95; SD=10.36). A descriptive cross-sectional study was conducted based on questionnaires as well as cooximetry. Results Forty-eight subjects (5.7%; 95% CI: 4.3%–7.5%) were smokers and 438 (51.8%; 95% CI: 48.5%–55.2%) were ex-smokers. The percentage of active smokers was higher in the 60 years or less subject group (χ 2; P<0.001). The large majority (75%) of smokers were men, their proportion being significantly higher than that of current non-smokers (χ 2; P<0.003). The mean score in the Fagerström Test was 3.6. More than 65% of smokers had their first cigarette up to 30 min from getting up in the morning, and 45% of these were in a preparation phase. Seventeen percent of these subjects said that they had not received advice on quitting smoking. Conclusions There is a high rate of smoking in patients on LTDOT, with a higher probability of males and younger subjects continuing to smoke. There is a high level of physical dependency for nicotine.

Study on knowledge-attitude-practice in patients with chronic obstructive pulmonary disease and need for education

Objective To know the status of knowledge-attitude-practice (KAP) in patients with chronic obstructive pulmonary disease(COPD), and to provide the basis for further developing the health education. Methods self-designed questionnaire survey was conducted among 206 COPD patients coming from four Class 3 Grade A comprehensive hospitals in Chongqing according to the convenience sampling principle. Results Among these subjects, the average correct rates of knowledge about risk factors and rehabilitation were 79.05% and 78.76%, respectively, and which about long-term domiciliary oxygen therapy (LTDOT) and medication treatment were 25.89% and 41.70%, respectively. 69.66% of them had active and correct belief and attitude regarding their disease. And only 18% of subjects could often insist the breath training exercise, and 51% of subjects could insist the physical exercise regularly. 94.2% of subjects wanted to gain the disease-related knowledge which mainly included the prevention, treatment and rehabilitation. The scores of KAP had no statistical significance for these patients with different education level (P>0.05). Conclusions The health-related KAP levels are not enough in COPD patients, and most of them desire these knowledge. The contents of health education of COPD should have emphasis and pertinence, especially emphasize the healthy behavior. Key words: Obstructive pulmonary disease; Knowledge; Attitude; Practice; Health education

Domowe leczenie tlenem (DLT) w Polsce w latach 1986–2005

Long-term domiciliary oxygen therapy (LTOT) is part to of pulmonary care system. Uniform qualification criteria and methods of follow-up for patients undergoing LTOT have been adopted. There are 63 LTOT centres located in Poland run by specialists in pulmonology. On the occasion of 20 years of LTOT in Poland, an analysis of its development, number of patients treated, diagnoses, survival and equipment was performed. Data were taken from structurized LTOT centres reports. A history of LTOT may be divided into 3 periods, steady grow in the years 1986-1991, stagnation between 1992-2000 and rapid grow in the last 3 years. On 01.01.2006 there was 2601 patients receiving LTOT therapy. The most common diagnosis was COPD (85%) followed by kyphoscolisis (5%), TB sequels (4.6%), IPF (3.6%) and other rare diseases. Treatment is reimbursed by the National Health System. Oxygen is administered via an oxygen concentrator. Due to insufficient resources from the NHS the needs for LTOT treatment are not fulfilled. There are 8.4 patients treated with LTOT per 100 000 people, with large regional differences ranging from 3.7 to 14.9/100 000. The most frequent cause of death in patients receiving LTOT treatment was exacerbation of respiratory failure (71.3%), followed by sudden death (5.1%), myocardial infarction or pulmonary embolism (4.4%), lung cancer (4%) and other or not known causes (15.2%). Survival in patients receiving LTOT treatment from the years 1986-1995 was rather short: 54.6% survived less than 3 years, 3-4 years survived 13.3%, 4-5 years 11.3% and more than 5 years survived 19.7% of treated patients.

Eligibility testing for long-term domiciliary oxygen therapy: more often, more effective?

Long-term oxygen therapy (LTOT) is used in patients with chronic hypoxemia in order to delay disease progression and increase survival. Current guidelines provide the criteria for LTOT prescription, outlining the requirements for both chronic hypoxemia and clinical stability documentation. However, in clinical practice, the physiological criterion prevails and, therefore, unstable patients that are considered eligible for LTOT are found to be ineligible at the next eligibility assessments. Moreover, many LTOT providers request eligibility recertification 1 year after initial prescription. In this way, many ineligible patients receive LTOT inappropriately until the reassessment and significant financial resources are wasted. Guidelines for LTOT prescription currently recommend an intermediate eligibility reassessment 2 months after the first LTOT prescription and the existing data support this approach. The current randomized study evaluates the effectiveness of an alternative eligibility testing approach with scheduled intermediate assessments, versus a conventional approach without, in terms of detection of eligible patients, oxygen cost savings and health resource utilization.

Difficulties and coping in daily living for patients living alone with long-term domiciliary oxygen therapy

Difficulties and coping in daily living for patients living alone with long-term domiciliary oxygen therapy

Self-esteem and relevant factors in the patients with long-term domiciliary oxygen therapy

Self-esteem and relevant factors in the patients with long-term domiciliary oxygen therapy

Emotions in patients with chronic obstructive pulmonary disease expecting long-term domiciliary oxygen therapy

Emotions in patients with chronic obstructive pulmonary disease expecting long-term domiciliary oxygen therapy

Inhaled corticosteroids and survival in COPD patients receiving long-term home oxygen therapy

Several observational studies suggest that therapy with inhaled corticosteroids (ICS) is associated with reduced mortality in patients with chronic obstructive pulmonary disease (COPD). However, none of these has reported survival data in COPD patients with respiratory insufficiency who require domiciliary oxygen therapy. The present study was conducted to examine the association between ICS and all-cause mortality in patients with severe COPD and chronic hypoxemia. From a tertiary referral clinic, we identified 145 consecutive COPD patients who met the criteria for long-term oxygen therapy between 1996 and 2002. We compared the hazard ratio (HR) for all-cause mortality over 1 year between patients who were (n=55) and were not treated with ICS (n=90). In a crude analysis, the use of ICS was associated with a HR of 0.38 (95% confidence interval (CI)=0.18-0.79). After adjustments for age, sex, use of oral steroids, and beta2-agonists, PaO2 and PaCO2, the HR was 0.46 (95% CI=0.21-0.98). Our findings indicate that ICS may reduce all-cause mortality in patients with severe COPD and chronic hypoxemia, who require long-term domiciliary oxygen therapy. These data suggest that ICS may play an important role in improving clinical outcomes in patients with advanced COPD.

Asthma is not a common cause of severe chronic respiratory failure in non-smokers: ALOT study

Little is known about the long-term natural history of asthma and the long-term clinical and functional consequences in non-smoking patients. From a functional point of view, non-smoking asthmatic patients may have a significantly greater decline in forced expiratory volume in one second (FEV1) compared with non-asthmatic subjects and may develop chronic irreversible (fixed) airflow limitation. This has been related to the physiological consequences of chronic airway inflammation causing airway remodeling. However these lesions are all potentially reversible and there is little radiological evidence indicating lung destruction (pulmonary emphysema), which is potentially irreversible, in non-smoking asthmatics. Severe chronic respiratory failure is the major cause of mortality in patients with severe chronic lung diseases. Domiciliary long-term oxygen therapy (LTOT) is an accepted treatment for patients with severe chronic respiratory failure. Our reasoning, therefore, was that if asthma is a cause of severe chronic respiratory failure in non-smokers we should be able to find non-smoking asthmatics within a large population of patients on LTOT. The aim of our study (Asthma and Long-term Oxygen Therapy, "ALOT") was to investigate the prevalence of non-smoking asthmatics in patients on LTOT in a multi-centre, cross-sectional study. Between June and September 2003 we screened all subjects on long-term domiciliary oxygen therapy in three different hospitals in the North-East area of Italy (within the provinces of Ferrara and Bologna). Taken collectively, we have found one-hundred and eighty-four patients on LTOT. We have reviewed their clinical data (age, sex, smoking, history and physical examination, arterial blood gas analysis, pulmonary function). 114 patients (all smokers) fulfilled the diagnostic criteria for COPD. Seventy patients (all smokers) had other diseases. We were unable to find any non-smokers in our screened population of subjects on long-term domiciliary oxygen therapy. Furthermore, there was no past history of asthma and/or acute wheezing episodes in either of the patient groups. This data suggests that asthma is an uncommon cause of severe chronic respiratory failure necessitating long-term domiciliary oxygen therapy in non-smokers and supports the current consensus that asthma and COPD are different diseases with differing stages of severity and the concept that long-term avoidance of active smoking is fundamental for the prevention of severe chronic respiratory failure.

Population-based data as an important contribution to better investigate chronic respiratory diseases

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A Randomized Trial of Strategies for Assessing Eligibility for Long-Term Domiciliary Oxygen Therapy

Restricting oxygen administration to those who benefit is desirable. To determine the impact of alternative strategies for assessing eligibility for domiciliary oxygen on funded oxygen use, quality of life, and costs. We randomized applicants for domiciliary oxygen therapy to an assessment system that relied on data collected by oxygen providers at the time of application and judgments by Home Oxygen Program personnel (conventional assessment) or to a system of data collection by a respiratory therapist that included, in patients unstable at the time of initial assessment, a repeat assessment after 2 months of stability (alternative assessment). A total of 276 applicants were allocated to the conventional arm and 270 to the alternative assessment. In the year after application, oxygen use was lower in the alternative arm with no between-group differences in mortality, quality of life, or resource use in the community. Although alternative assessment applicants had on average higher assessment costs by dollars Canadian 155 per applicant, these costs were more than offset by decreased Home Oxygen Program costs of dollars Canadian 596 per applicant using Canadian cost weights. The comparable U.S. dollar figures were dollars US 309 and dollars US 432, respectively, and the difference in cost between strategies was therefore smaller using U.S. cost weights. Reassessment of applicants for domiciliary oxygen after several months of stability identifies an appreciable portion of initially eligible patients who are no longer eligible, thus reducing program costs to public funders without adverse consequences on quality of life, mortality, or other resource use.

Cognitive Decline in Patients with Long-Term Domiciliary Oxygen Therapy

Cognitive and psycho-physiological condition in patients with long-term domiciliary oxygen therapy (DOT) remains uncertain. A cross sectional analysis was performed to investigate the age-related changes in cognitive and psycho-physiologic functions in patients with chronic respiratory failure receiving long-term DOT. Two expert practitioners visited the patient's home and examined them for analysis of cognitive function, emotional status, physical activity and degree of dyspneic sensation. One hundred and thirty-five patients completed the study. Control data from a cohort of 718 community dwellers were also included in this study. Male patients had significantly higher rates of chronic obstructive pulmonary disease (71% vs 47%, p = 0.001), lower values of forced expiratory volume in one second (FEV1.0) % (49.7 +/- 10.3 [standard deviation, S.D.] vs 66.0 +/- 7.5% predicted, p = 0.002) and higher Borg score, an indicator of dyspneic sensation, during daily exercise (3.2 +/- 0.8 [S.D.] vs 1.4 +/- 0.6, p = 0.01) compared with female patients. Linear regression analysis based on mean Mini-Mental State Examination scores, an indicator of cognitive function, showed that age-related cognitive decline was more pronounced in female patients than in female controls (-0.524/year, R2 = 0.426 vs -0.120/year, R2 = 0.027, p < 0.0001), while there was no significant difference between male patients and male controls (-0.156/year, R2 = 0.054, vs -0.077/year, R2 = 0.016, p = 0.231). These results demonstrate that age-related cognitive decline is more exaggerated in female patients receiving long-term DOT which should be taken into consideration in caring for patients with chronic respiratory failure.

Nutritional depletion in relation to mortality in patients with chronic respiratory insufficiency treated with long-term oxygen therapy

An association between malnutrition, weight loss and mortality has been demonstrated in patients with chronic obstructive pulmonary disease (COPD), but the prognostic influence of low body-mass index (BMI) and plasma concentrations of albumin and cholesterol is less clear in patients with chronic respiratory insufficiency treated with domiciliary long-term oxygen therapy (LTOT). We therefore analysed the prognostic value of BMI, plasma albumin and cholesterol concentrations in patients receiving LTOT. From 1996 to 2001, LTOT was initiated in 255 patients. Analysis of the impact of nutritional status on survival was confined to a study group of 108 patients in whom the main outcomes, i.e. BMI, plasma cholesterol and albumin, were measured. Standard laboratory methods were used in the biochemical analyses. Pulmonary function was assessed with bodyplethysmography. 63 patients (58.3%) survived for two years post-initiation of LTOT and 45 patients (41.7%) did not. There were no differences between these two groups in pulmonary function tests and arterial blood gases at the start of LTOT. Overall, 10.2% of the study population were underweight, defined as BMI <20 kg/m2. Compared with patients who survived two years of LTOT, those who did not survive were older (69.3+/-0.9 versus 64.7+/-1.2 years, p<0.01), had significantly lower BMI (24.5+/-0.7 versus 26.5+/-0.7 kg/m2, p < 0.05), lower plasma cholesterol (4.61+/-0.19 versus 5.22+/-0.13 mmol/l, p<0.01) and lower plasma albumin concentrations (41.4+/-0.4 versus 42.8+/-0.4 g/l, p <0.05). Logistic regression analysis revealed that, in addition to age (p < 0.01), both BMI (p < 0.05) and cholesterol (p < 0.05) significantly affected the 2-year survival. This study suggests that nutritional status is closely linked with prognosis in patients with chronic respiratory insufficiency treated with domiciliary LTOT: low BMI, low plasma cholesterol and low albumin are related to worse 2-year survival in such patients.