Long-term Oxygen Therapy In Patients Research Articles

Patient-Assessed Quality of Virtual Consultations as Follow-Up on Long-Term Oxygen Therapy for Patients With COPD.

Long-term oxygen therapy (LTOT) can increase survival time and relieve symptom burden in patients with COPD and chronic hypoxemia. The Department of Respiratory Medicine at Odense University Hospital invites patients with LTOT and COPD to the out-patient clinic for treatment evaluation every 6 months to regulate or terminate treatment and support patients' treatment adherence. The out-patient clinic, however, experiences many absences or cancellations from patients. For that reason, patients were offered virtual consultation as an alternative to physical attendance. This study was initiated to uncover reasons for absences and the patients' experiences of virtual consultation to promote a more patient-centered clinical practice for patients with COPD and LTOT. A qualitative study encompassing semi-structured interviews with 20 subjects was conducted in the winter of 2021. The subjects had tried or been given the opportunity of virtual consultation. Data were analyzed inspired by Kvale and Brinkmann focusing on the subject's perspectives on virtual consultation. The analysis resulted in 3 main themes: limitations and vulnerabilities, independence and quality of life, and personal strategies. Subjects expressed that everyday life with LTOT and COPD was characterized by limited resources in terms of energy, oxygen, and time. LTOT was perceived as a necessary means to maintain a sense of independence and quality of life. However, LTOT also meant additional limitations due to cumbersome equipment and feelings of isolation. Most subjects considered the virtual consultation to be oxygen-, energy-, and time-preserving, as it meant avoiding stressful transportation and handling of oxygen cylinders, COVID-19 exposure, waiting time, and not having to involve others for help. The subjects' perspective showed that follow-up on LTOT as a virtual consultation was considered a valuable offer. The chosen method was found to be relevant in uncovering subjects' attitudes toward clinical practice procedures.

Экономическая эффективность длительной кислородотерапии у больных бронхолегочными заболеваниями с тяжелой хронической артериальной гипоксемией

Background: long-term oxygen therapy (LTOT) for chronic lung diseases associated with chronic hy-poxemia is effective in terms of increasing life expectancy. However, by now, the costs of LTOT are not reimbursed by the healthcare system of the Russian Federation. Aim: to evaluate the economic efficiency of respiratory therapy centers in providing pa-tients with chronic lung diseases and severe chronic hypoxemia with LTOT at home. Patients and Methods: direct medical and nonmedical costs associated with the introduc-tion of LTOT into clinical practice were identified and calculated. Costs of LTOT, outpatient management of patients without exacerbations, treatment for exacerbations, and disability-related payments were considered. Clinical and economic modeling was performed. A cost-effectiveness analysis was performed and the budget impact was assessed. Published data and the experience of St. Petersburg Regional Respiratory Support Center were used to evaluate LTOT efficacy. Results: additional costs for LTOT per patient for 5 years are 229,759 RUB. LTOT signif-icantly (by 74%) reduce the costs of treating patients with exacerbations of chronic obstructive pulmonary disease, mainly due to a reduction in exacerbation rate, including those requiring ad- mission to hospital. Analysis of budget impact over 5 years demonstrates a decrease in direct medical costs per 100 oxygen concentrators by 32% (from 181,666,728.90 RUB to 123,247,630.82 RUB). Given mortality, the estimated number of patients opting for LTOT using 100 oxygen concentrators over 5 years is 150. Conclusions: reimbursement for LTOT costs in Russian healthcare is economically reason-able. KEYWORDS: long-term oxygen therapy, economic efficiency, respiratory therapy center, cost-effectiveness analysis, chronic hypoxemia. FOR CITATION: Gomon Yu.M., Titova O.N., Kolbin A.S., Kuzubova N.A., Balykina Yu.E. Economic efficiency of long-term oxygen therapy in patients with chronic lung diseases and severe chronic hypoxemia. Russian Medical Inquiry. 2023;7(8):475–481 (in Russ.). DOI: 10.32364/2587-6821-2023-7-8-1.

Long-Term Oxygen Therapy in Patients with Pulmonary Artery Hypertension

Introduction: Dyspnea associated with pulmonary arterial hypertension (PAH) requires supplemental oxygen to maintain oxygen saturation. Many researches related to oxygen therapy in chronic obstructive pulmonary disease and cor pulmonale are available, but the effect of long-term oxygen therapy (LTOT) has not been explored in PAH patients. Aim: This study aimed to determine the effect of LTOT in patients diagnosed with PAH. Methodology: All adult patients with PAH, primary or secondary to respiratory disease who require LTOT, were included in the study. The following parameters were collected: age, gender, severity of PAH based on echocardiogram, body mass index, comorbidities, type of oxygen therapy device, amount and duration of oxygen usage, mortality, frequency of readmission, oxygenation, and vital sign parameters. Results: This was a retrospective study which included 332 participants diagnosed to have PAH after detailed echocardiogram assessment. Out of these, 32 participants were prescribed LTOT at the time of discharge. At the time of discharge, there was a significant improvement in all the vital signs and oxygenation variables. The increase in oxygenation, hemoglobin, and reduced respiratory rate after LTOT was statistically significant (P

Long-term oxygen therapy in COPD: what is the evidence?

Thomas L Petty was the founder of modern long-term oxygen therapy (LTOT).1 In 1967, Petty's group published the seminal study of six patients with severe chronic airway obstruction, in whom LTOT improved clinical status, exercise capacity, secondary erythrocythemia, and pulmonary hypertension.2 Notably, all patients had severe hypoxaemia (partial pressure of oxygen [PaO2] 41·5–46·5 mm Hg) and four patients were severely hypercapnic (partial pressure of carbon dioxide [PaCO2] 55·0–61·5 mm Hg). Thereafter, two randomised controlled trials that were initiated in the 1970s established a clear survival benefit related to LTOT in patients with chronic obstructive pulmonary disease (COPD) with severe resting hypoxaemia: the Nocturnal Oxygen Therapy Trial (NOTT)3 and the British Medical Research Council (BMRC) trial.

Cost-Effectiveness of an Extended Home Visit Program for Oxygen-Dependent COPD Patients.

Long-term oxygen therapy in COPD is usually supervised through home-care respiratory programs. Such programs often involve an intensive education intervention at the initiation of long-term oxygen therapy, followed by an extended follow-up period that aims toward home oxygen adherence. The objective of this study was to estimate the cost-effectiveness ratio of such a maintenance program. A simulation model was developed that compared 2 strategies after the intensive education intervention: (1) enrollment and (2) no enrollment in a maintenance program. The study population consisted of a hypothetical cohort of 200 patients (100 patients per group; mean age, 74 years; 45% men; mean FEV1 of 43% predicted value; and mean resting PaO2 while breathing air, 50 mm Hg). Effectiveness assumptions of the program were derived from a current literature review. The primary outcome was the ratio of the incremental cost of the program per quality-adjusted life-years gained. Only direct costs were considered; a health-care system perspective was adopted. Costs are reported in 2020 Canadian dollars (Can $). Over a 5-year period, an extended home-visit program may prevent 9 deaths and provide an additional 39 years of life and 24 quality-adjusted life-years. Compared with usual care (ie, no enrollment in the maintenance program), the incremental cost-effectiveness ratio was Can $17,197 per quality-adjusted life-years gained. Sensitivity analyses demonstrated the robustness of the model. Only a reduction in adherence of 25% per year would increase the incremental cost-effectiveness ratio per quality-adjusted life-years beyond the threshold of Can $50,000 that is usually considered as acceptable from a health-care system perspective. An extended home-visit program to maintain or improve adherence to long-term oxygen therapy in patients with COPD would most likely be cost-effective.

Multi‐disciplinary collaborative consensus guidance statement on the assessment and treatment of breathing discomfort and respiratory sequelae in patients with post‐acute sequelae of SARS‐CoV‐2 infection (PASC)

<scp>Multi‐disciplinary</scp> collaborative consensus guidance statement on the assessment and treatment of breathing discomfort and respiratory sequelae in patients with <scp>post‐acute</scp> sequelae of <scp>SARS‐CoV</scp>‐2 infection (<scp>PASC</scp>)

Providing Long-Term Oxygen Therapy for Patients with COPD and Interstitial Lung Disease

Sponsoring Organization: American Thoracic Society (ATS)BackgroundThis guideline is focused on long-term oxygen therapy (LTOT) for patients with

Randomized Trial of Nocturnal Oxygen in Chronic Obstructive Pulmonary Disease

BackgroundLong-term oxygen therapy improves survival in patients with chronic obstructive pulmonary disease (COPD) and chronic severe daytime hypoxemia. However, the efficacy of oxygen therapy for the management of isolated nocturnal hypoxemia is uncertain.MethodsWe designed this double-blind, placebo-controlled, randomized trial to determine, in patients with COPD who have nocturnal arterial oxygen desaturation without qualifying for long-term oxygen therapy, whether nocturnal oxygen provided for a period of 3 to 4 years would decrease mortality or the worsening of disease such that patients meet current specifications for long-term oxygen therapy. Patients with an oxygen saturation of less than 90% for at least 30% of the recording time on nocturnal oximetry were assigned, in a 1:1 ratio, to receive either nocturnal oxygen or ambient air from a sham concentrator (placebo). The primary outcome was a composite of death from any cause or a requirement for long-term oxygen therapy as defined by the Nocturnal Oxygen Therapy Trial (NOTT) criteria in the intention-to-treat population.ResultsRecruitment was stopped prematurely because of recruitment and retention difficulties after 243 patients, of a projected 600, had undergone randomization at 28 centers. At 3 years of follow-up, 39.0% of the patients assigned to nocturnal oxygen (48 of 123) and 42.0% of those assigned to placebo (50 of 119) met the NOTT-defined criteria for long-term oxygen therapy or had died (difference, −3.0 percentage points; 95% confidence interval, −15.1 to 9.1).ConclusionsOur underpowered trial provides no indication that nocturnal oxygen has a positive or negative effect on survival or progression to long-term oxygen therapy in patients with COPD. (Funded by the Canadian Institutes of Health Research; INOX ClinicalTrials.gov number, NCT01044628.)

Oxygen therapy in COPD and interstitial lung disease: navigating the knowns and unknowns.

Domiciliary oxygen therapy is often prescribed for patients with hypoxaemia due to advanced lung disease, most commonly chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). Long-term oxygen therapy (LTOT) trials conducted in patients with COPD in the 1980s remain the basis for clinical decisions and guideline recommendations regarding LTOT for patients with non-COPD conditions as there is a lack of high-quality evidence concerning its use in the non-COPD population. There is also a lack of evidence for the use of ambulatory and nocturnal oxygen therapy in patients with isolated exertional and nocturnal hypoxaemia. These deficiencies pose significant challenges in patient care, with consequent discrepancies in guideline recommendations and clinical approaches. In recent years, new studies have been and are currently being conducted to fill the gaps in our understanding and use of domiciliary oxygen therapy for other indications, including ILD. This article provides a comparison of the epidemiology and significance of hypoxaemia in patients with COPD and ILD, with an up-to-date review of current evidence regarding the role of different types of domiciliary oxygen therapy in these conditions.

Long-Term Oxygen Therapy in Patients With Chronic Obstructive Pulmonary Disease and Moderate Hypoxemia.

Long-Term Oxygen Therapy in Patients With Chronic Obstructive Pulmonary Disease and Moderate Hypoxemia.

Adherence to long-term oxygen therapy in patients with chronic obstructive pulmonary disease.

Long-term oxygen therapy (LTOT) has beneficial effects on survival in patients with chronic obstructive pulmonary disease (COPD) and severe hypoxemia at rest. Two landmark trials suggested that these benefits depend on the time of exposure to oxygen. Patients are usually prescribed LTOT for at least 15–18 hours/day. The primary objective of this study was to determine the average daily exposure to supplemental oxygen in patients with severely hypoxemic COPD who were newly prescribed LTOT and the proportion of patients who were adherent to their prescription. The secondary objective was to identify predictors of compliance to LTOT. We performed a retrospective observational study of patients newly registered in a regional home oxygen program in Quebec, Canada, between July 1, 2013, and December 31, 2014. Daily exposure to oxygen was objectively measured from the concentrator’s counter clock. From 196 patients registered in the program during the study period, 115 contributed to the analysis. Most patients (n = 84; 73%) were prescribed oxygen for ≥18 hours/day. Overall, the 115 patients were exposed to home oxygen for 17.8 hours/day; 60% of the patients were compliant according to our definition. Increasing age and ambulatory oxygen utilization predicted adherence to oxygen therapy. Adherence to home oxygen therapy is suboptimal. Behavioral and psychological interventions to improve compliance to LTOT should be investigated.

Clinical outcome of 1-year long-term oxygen therapy in patients with chronic obstructive pulmonary disease

Background Long-term oxygen therapy (LTOT) is a well-established treatment that shows definite survival benefit in patients with chronic obstructive pulmonary diseases (COPD) associated with severe hypoxemia. Objective A randomized, prospective, analytic case study was done to evaluate the effect of LTOT in patients with COPD associated with severe hypoxemia. Patients and methods Forty-eight patients with COPD with severe hypoxemia randomly selected from patients admitted at Chest department at Assuit University Hospital were enrolled in this study. Pulmonary function test, 6-min walk test, St George’s Respiratory Questionnaire, arterial blood gases, BMI and periodic maintenance were assessed in all patients. Results Significant improvement in oxygen tension and oxygen saturation was detected after 6 months of use of LTOT in the studied patients. Oxygen saturation (SO2) during 6-min walk test showed statistically significant improvement after 6-month follow-up. Marked reduction in the number of exacerbation and subsequently number of hospitalization as well was observed. Patients reported significant improvement in all components of St George’s quality-of-life questionnaire, activity, effects, symptoms, and total score. Survival outcome of the patients after 1-year follow-up was 87%. Conclusion LTOT significantly improves survival among patients with COPD, as it decreases the number of hospitalization and improves the quality of life among these patients.

Long-Term Oxygen Therapy in COPD: evidences and open questions of current indications

Long term oxygen therapy (LTOT) has been shown to improve the survival rate in Chronic Obstructive Pulmonary Disease (COPD) patients with severe resting hypoxemia by NOTT and MRC studies, published more than 25 years ago. The improved survival was found in patients who received oxygen for more than 15 hours/day. The effectiveness of LTOT has been documented only in stable COPD patients with severe chronic hypoxemia at rest (PaO2 < 55 mmHg (7.3 kPa) or PaO2 ranging from 56 to 59 mmHg (7.4-7.8 kPa) in presence of signs of Cor Pulmonale, hematocrit > 55%. In fact no evidence supports the use of LTOT in COPD patients with moderate hypoxemia (55 < PaO2 < 65 mmHg), and in those with decreased oxygen saturation (SO 2 <90%) during exercise or sleep. Furthermore, it is generally accepted without evidence that LTOT in clinical practice is warranted in other forms of chronic respiratory failure not due to COPD when a-terial blood gas criteria match those established for COPD patients. The prescription of oxygen in these circumstances, as for unstable patients, increases the number of patients receiving supplemental oxygen and the related costs. Comorbidities are likely to affect both prognosis and health outcomes in COPD patients, but at the moment we do not know if LTOT in these patients with complex chronic diseases and mild-moderate hypoxemia could be of any use. For these reasons a critical revision of the actual guide lines indications for LTOT in order to optimise effectiveness and costs, and future research in the areas that have not previously been addressed by NOTT and MRC studies, are mandatory.

Long-term oxygen therapy

Long-term oxygen therapy (LTOT) has been shown to reduce pulmonary hypertension and improve survival in patients with chronic obstructive pulmonary disease and resting hypoxemia (reduced arterial partial pressure of oxygen ≤55 mmHg). However, the benefit of its use for chronic pulmonary diseases other than chronic obstructive pulmonary disease as well as for nonpulmonary conditions is debatable. Its role in patients with mild hypoxemia (reduced arterial partial pressure of oxygen >55 mmHg at rest) is presently being investigated in the LOTT. A meta-analysis of four controlled trials reporting the role of LTOT in patients with either nocturnal desaturation or daytime moderate hypoxemia found no difference in survival between patients on LTOT than those without. Advances in oxygen delivery and conservation devices have made domiciliary oxygen therapy more practical and popular for patients. There still remain concerns with the actual compliance of therapy among the needy patients.

A first step against idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is a chronic devastating disease affecting 50 to 300 individuals per million with a median survival time of ∼3 yrs [1]. The recent publication of evidence-based guidelines for the diagnosis and management of patients with IPF did not provide patients and care givers with any reason for optimism [2]. The only recommended procedures in this document were: long-term oxygen therapy in patients with clinically significant hypoxaemia; lung transplantation in selected patients; treatment of asymptomatic gastro-oesophageal reflux (although there is not even one randomised trial showing that this treatment improves lung function decline or survival in IPF patients); pulmonary rehabilitation; and corticosteroid use in patients with acute exacerbation of IPF [3]. Almost all treatment procedures evaluated in that statement were given either a weak or a strong recommendation against use [2]. However, the litany of the negative therapeutic trials in IPF ended with the recent publication of the results of three phase III trials evaluating the efficacy of pirfenidone [4–6]. The results of these trials, including >1,000 …

Treatment of respiratory failure in COPD

Patients with advanced COPD and acute or chronic respiratory failure are at high risk for death. Beyond pharmacological treatment, supplemental oxygen and mechanical ventilation are major treatment options. This review describes the physiological concepts underlying respiratory failure and its therapy, as well as important treatment outcomes. The rationale for the controlled supply of oxygen in acute hypoxic respiratory failure is undisputed. There is also a clear survival benefit from long-term oxygen therapy in patients withchronic hypoxia, while in mild, nocturnal, or exercise-induced hypoxemia such long-term benefits appear questionable. Furthermore, much evidence supports the use of non-invasive positivepressure ventilation in acute hypercapnic respiratory failure. It application reduces intubation and mortality rates, and the duration of intensive care unit or hospital stays, particularly in the presence of mild to moderate respiratory acidosis. COPD with chronic hypercapnic respiratory failurebecame a major indication for domiciliary mechanical ventilation, based on pathophysiological reasoning and on data regarding symptoms and quality of life. Still, however, its relevance for long-term survival has to be substantiated in prospective controlled studies. Such studies might preferentially recruit patients with repeated hypercapnic decompensation or a high risk for death, while ensuring effective ventilation and the patients' adherence to therapy.

Long-term oxygen therapy: are we prescribing appropriately?

Long-term oxygen therapy (LTOT) is the treatment proven to improve survival in chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure. It also appears to reduce the number of hospitalizations, increase effort capacity, and improve health-related quality of life. Standard LTOT criteria are related to COPD patients who have PaO2 < 60 mmHg, are in a clinical stable situation, and are receiving optimal pharmacological treatment. According to LTOT guidelines, oxygen should be prescribed for at least 18 hours per day although some authors consider 24 hours would be more beneficial. The benefits of LTOT depend on correction of hypoxemia. Arterial blood gases should be measured at rest. During exercise, an effort test should be done to assure adequate SaO2. During sleep, continuous monitoring of SaO2 and PaCO2 should be performed to confirm correction of SaO2 overnight. An arterial blood gas sample should be taken at awakening to assess PaCO, in order to prevent hypoventilation from the oxygen therapy. Several issues that need to be addressed are the use of LTOT in COPD patients with moderate hypoxemia, the efficacy of LTOT in patients who desaturate during exercise or during sleep, the optimal dosage of oxygen supplementation, LTOT compliance, and the LTOT prescription in diseases other than COPD.

Rechtsherzinsuffizienz und Cor pulmonale

Whereas the right ventricle tolerates volume loads without any substantial increase of the pressure in the pulmonary circulation by recruiting capacitance vessels and capillaries, it possesses only small contractile reserves and reacts unadapted with right ventricular dysfunction. Its size and pressure load are relevant factors for prognosis of all forms of pulmonary hypertension, in particular if linked to left-sided heart failure. Differentiation of pulmonary hypertension according to the Venice classification is highly important. Right-sided ventricular heart failure worsens left ventricular hemodynamics due to reduced ejection fraction and in addition due to direct diastolic ventricular interaction in which left ventricular diastolic dysfunction increases even though the left ventricular systolic function is still intact. Right ventricular ejection fraction <40% is an important predictor of prognosis after myocardial infarction or chronic stages of left ventricular heart failure. The most important noninvasive diagnostic method is transthoracic echocardiography with determination of the Tei index and Doppler echocardiographic estimation of pulmonary artery pressure. Chronic obstructive pulmonary disease is the most frequent cause of cor pulmonale. While long-term oxygen therapy in patients with COPD and cor pulmonale and for example the administration of endothelin receptor antagonists in patients with idiopathic pulmonary hypertension is beneficial, the therapeutic use of drugs effective for left-sided heart failure is very limited in patients with right ventricular dysfunction.

Long-Term Oxygen Therapy in Chronic Obstructive Pulmonary Disease: The Use of Concentrators and Liquid Oxygen Systems in North-Western Greece

Background: Long-term oxygen therapy (LTOT) is the cornerstone mode of treatment in patients with chronic obstructive pulmonary disease (COPD). Objectives: The present study aims to investigate the effect of two oxygen sources (concentrator and liquid oxygen) on quality of life, exercise tolerance and compliance to LTOT in patients with COPD. Methods: The survey included 104 patients with COPD (31 on concentrator treatment and 73 on liquid oxygen). Patients were subjected to pulse oximetry, basic spirometry, measurement of health-related quality of life by the St. George’s Hospital respiratory questionnaire instrument and assessment of dyspnoea severity by the modified Borg category scale. Exercise tolerance was evaluated by the S_aO₂ value after 3 min of walking. S_aO₂ was measured before and after treatment with each device. Compliance with therapy was defined by the daily duration of oxygen use. Results: The two LTOT groups did not differ significantly concerning pulmonary function tests (p = 0.49 for FEV₁, 0.98 for FVC, 0.15 for FEV₁/FVC% and 0.38 for FEF_50%), S_aO₂ before (p = 0.28) and after (p = 0.80) O₂ treatment and after the 3-min walking trial (p = 0.47), and St. George’s Hospital respiratory questionnaire score (p = 0.45). The liquid oxygen group was less dyspnoeic before treatment (p = 0.02), but this difference disappeared after treatment (p = 0.95). A highly significant difference (p < 0.001) was noted concerning the daily oxygen use. Complete compliance to LTOT (≧15 h/day) was observed in 12.9 and 42.5%, respectively (p < 0.005). Noise disturbance was noted only in the concentrator group (80%). Conclusions: We conclude that stationary liquid oxygen seems to be a satisfactory alternative mode for LTOT treatment in COPD patients, with higher patient compliance to therapy in comparison with concentrators.

Long-term oxygen therapy in patients with chronic respiratory failure in one university hospital

Background : Although home oxygen therapy in hypoxemic patients with chronic lung disease has been increasing over the decade in Korea, the present state has not been known well. This study was done to know the situation of home oxygen therapy in a Korean university hospital. Methods : Between January 1, 2000 and August 31, 2003, 86 patients prescribed home oxygen therapy by the pulmonary physicians of Asan Medical Center were investigated using their medical record and questionnaire. Results : Patients (52 men, mean age of 61 years) with home oxygen therapy were increasing by every year. Underlying diseases were COPD (n=29), tuberculous destroyed lung (n=18), bronchiectasis (n=15), ILD (n=12), and others. Baseline , FVC, and of patients were , of predicted, and of pred. Mean oxygen flow was 1.5 L/min and mean duration per day was 14.5 hours. During therapy, mean values have increased from 51.2 to 77.7 mm Hg and values have increased from 47.5 to 49.6 mm Hg. Only 16.5% of the subjects were monitored by visiting nurses or pulse oximeter. Three year survival rate was 56.6% and hypercapnic patients showed better prognosis. Conclusion : The patients with home oxygen therapy were increasing yearly and a part of them were monitored. The hypercapnea respiratory failure patients would have better prognosis.