Long-term oxygen therapy at home. Compliance with medical prescription and effective use of therapy. ANTADIR Working Group on Oxygen Therapy. Association Nationale de Traitement à Domicile des Insuffisants Respiratories (original) (raw)
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Assessment and follow up of patients prescribed long term oxygen treatment
Thorax, 1993
Background-Prescription and use of long term oxygen treatment were audited in a large group of patients after more than five years of use of the guidelines for its prescription. Methods-Patients with a concentrator were interviewed at home with a structured questionnaire in three family health service authorities in East London. Stable oxygen saturation (Sao,) breathing air and oxygen, forced expiratory volume in one second (FEV,) and current and previous dated concentrator meter readings were recorded. A firther questionnaire was sent to each patient's general practitioner. Hospital case notes of patients who did not meet the criteria for long term oxygen treatment at reassessment were reviewed. Results-A total of 176 patients were studied; 84% had chronic obstructive lung disease and 190/o admitted to continued smoking; 140 patients had seen a respiratory physician but results of respiratory assessment were available to their general practioner in fewer than 54 cases. FEV, was <1 5 1 in 158 patients but in 67 Sao, was less than 91% breathing air, mainly in patients with chronic obstructive lung disease who had been inadequately assessed. Daily oxygen was prescribed for a median of 15 (range 4-24) hours and measured daily use was 15 (0-24) hours; 74% of patients used more than 12 hours. Only 35 patients had problems with oxygen treatment, but 29 had an undercorrected Sao, of less than 92% when using their concentrator. Conclusions-Guidelines for prescription of long term oxygen treatment are Department of
Poor Adherence to Guidelines for Long-Term Oxygen Therapy
CHEST Journal, 2009
Long-term oxygen therapy (LTOT) improves survival in patients with chronic obstructive pulmonary disease (COPD) and severe hypoxemia. Adherence to LTOT guidelines is problematic, both because efficacy has been demonstrated only in specific groups of COPD patients, and because it implies high costs. Introduces treatment high costs. The aim of our study was to examine retrospectively the adherence to LTOT guidelines in a sample of medical records of patients prescribed LTOT between January 2005 and December 2006 in two Italian university hospitals (Ferrara and Modena). Out of a total of 191 medical records of patients prescribed LTOT, only 157 had adequate clinical data considering the three main criteria for appropriateness (arterial blood gas and/or pulse oximetry measurement, oxygen administration, smoking status). Out of these 157 patients, only 73 (46.5 %) fulfilled all three criteria recommended by the guidelines. Adherence was higher for LTOT prescribed by pulmonologists compared to internists. This survey showed that the adherence to LTOT guidelines in a sample of medical records of patients prescribed LTOT is poor. Considering the high costs and the impact on the patients' quality of life of LTOT, these results suggest that the adherence should be carefully monitored.
Respiratory Medicine, 2001
About half of all patients on home oxygen therapy receive non-continuous oxygen therapy (less than 15 h daily) (NCOT).The goal of NCOT is to improve well-being during daily activities and to improve sleep quality.The aim of this study was to evaluate the e¡ect of NCOT on pulmonary symptoms and sleep quality, and to determine whether patients with a subjective bene¢cial e¡ect di¡ered from those without e¡ect in terms of patients'characteristics, utilization of oxygen, hospitalization and survival. Furthermore, the relationship between the reported bene¢cial e¡ect of NCOTon dyspnoea and physical activity during domestic activities was examined. During the period November 1994 to July 1995, 254 Danish patients were prescribed oxygen less than 12 h daily or 'on demand'. Of these patients, 142 (55?9%) answered a questionnaire on hours spent with oxygen and symptomatic e¡ect of oxygen treatment.While on oxygen, 76?3% of the patients reported improved dyspnoea score (0^10) more than 0?5 points, 78?3% had improved qualityof life, 59?5% improved sleep,48?5% increased physical activity,49?3% feltless tired and 40?0% reported improved thinking. Fifty-seven (43?2%) patients reported both improved dyspnoea and physical activity, whereas seven (5?3%) patients reported that oxygen had no e¡ect on dyspnoea but a bene¢cial e¡ect on physical activity.Only 11 (7?7%) patients reported no subjective improvement on oxygen.The subjective e¡ect of NCOTwas not signi¢cantly associated to hours spent with oxygen, the underlyingdisease, gender, hospitalization or survival.During dailyactivityandregardless of daily number of hours spent with oxygen, NCOT improved well-being in nearly all patients. The most pronounced improvement was reported on dyspnoea, sleep and qualityof life.Very few patients sensedimproved physical activity without relief in breathlessness.r 2001Harcourt Publishers Ltd
Respiratory Medicine, 2006
Background: The adherence to the prescribed oxygen therapy is difficult to obtain for patients on long-term oxygen therapy (LTOT). There is little information on the modalities of oxygen utilisation for patients on LTOT who are using liquid oxygen in real life. Study objective: Evaluation of the behaviour and the knowledge regarding LTOT in a large group of patients mainly using liquid oxygen. Design and setting: Questionnaire administered to consecutive outpatients on domiciliary LTOT for at least 6 months referring to one of 20 clinics throughout Italy. Blinded to this result, the physician who cared for the patient completed another questionnaire. Results: We evaluated 1504 patients (mean age 71.6 years; males 64%; 74% suffering from COPD). Most respondents (93%) used liquid oxygen with mobile device. Fifteen per cent of patients had a prescribed length of oxygen therapy less than 15 h/day; 21% reported to practice oxygen for less than 15 h/day. Patients reported using
Oxygen therapy in chronic obstructive pulmonary disease
Proceedings of the American Thoracic Society, 2008
Since the introduction of oxygen as a therapeutic agent 70 years ago, much has been learned regarding the detrimental effects of hypoxemia and the beneficial impact of oxygen therapy. It is projected that there are close to 800,000 patients receiving long-term oxygen therapy (LTOT) in the United States, at a cost of approximately $1.8 billion annually. The large numbers of patients receiving supplemental oxygen as treatment and the high costs incurred in providing oxygen therapy necessitate the practitioner to know the indications for LTOT as well its effects on survival, pulmonary hemodynamics, sleep, and exercise capacity. It is now recognized that the basis for LTOT prescription for all patients is founded on data that are over 25 years old and that only involve a very select cohort of patients. It is clear that further studies are required to assess the effects of oxygen on patients with chronic obstructive pulmonary disease with only mild hypoxemia, not only survival but also on neurocognitive function, quality of life, exercise physiology, and sleep quality. In addition, although proven to be safe when prescribed long term to individuals with lung disease, there are some concerns about worsening carbon dioxide retention and increased oxidant injury. The goals of this article are to briefly describe the indications for chronic oxygen administration, the physiologic effects of treatment, and potential toxicities, as well as its effect on morbidity and mortality.
A Retrospective Observational Study of Domiciliary Oxygen Usage in a Subset of Veterans
Respiratory Care, 2020
BACKGROUND: Long-term oxygen therapy (LTOT) delivered continuously is known to decrease mortality in patients with COPD and who are hypoxemic; however, supportive data for LTOT use in patients without COPD is lacking. In addition, many patients may be prescribed LTOT without a definitive etiology for hypoxemia. First, we investigated the diagnoses for which oxygen was prescribed to a sample of veterans and whether each diagnosis was supported by confirmatory testing. Second, we looked at the proportion of subjects who were prescribed non-continuous therapy. METHODS: We retrospectively studied subjects prescribed domiciliary oxygen at the Veterans Administration Western New York Healthcare System. The subjects who met inclusion criteria were identified by using a computerized patient record system; data were collected on subject characteristics, oxygen prescription information, diagnosis for hypoxia, and diagnostic workup. Descriptive data were presented as mean 6 SD and median (range). Statistical analysis was performed by using the chi-square test and an unpaired t test. RESULTS: A total of 494 patients were included: 96.8% men, mean 6 SD ages 74.2 6 10.8 y. Most of the subjects were prescribed oxygen as outpatients (68.5%). A total of 335 (67.8%) were prescribed oxygen for continuous therapy, 72 (14.1%) for nocturnal therapy, 50 (10.1%) for exertion, and 30 (6.1%) for both exertion and nocturnal use. At 3 months, 19.6% of the initial cohort had oxygen discontinued. In those subjects with oxygen continued at 3 months, COPD was the most common diagnosis (63.6%), of which 76.1% had pulmonary function tests (PFTs), with 85.7% showing obstruction on spirometry. CONCLUSIONS: Results of our study showed a 99.4% adherence to Medicare criteria for domiciliary oxygen prescription. Also, 30.3% of the subjects were prescribed LTOT for exertional or nocturnal desaturation or both. Repeated testing at 3 months identified subjects who no longer required oxygen. COPD was the most common etiology for domiciliary oxygen. A small proportion of the subjects (6.9%) were prescribed oxygen without underlying etiology for hypoxia. Exertional and/or nocturnal oxygen prescription was common, and further research to elucidate its utility is clearly warranted.
Overnight prescription of oxygen in long term oxygen therapy: time to reconsider the guidelines?
Thorax, 2006
Background: Guidelines for long term oxygen therapy (LTOT) recommend increasing oxygen flow by 1 l/min overnight. A study was undertaken in patients with COPD on LTOT to determine the prevalence of overnight desaturation if the usual oxygen flow rate is not increased at night, whether resting oxygen saturation predicts overnight desaturation, and whether overnight desaturation correlates with health related quality of life (HRQL) and sleep quality. Methods: A cross sectional prospective study was performed on consecutive patients with COPD on LTOT attending our regional outpatient oxygen service. All patients fulfilled standard criteria for LTOT, had been established on LTOT at a flow to achieve resting oxygen saturations .90%, but had not been instructed to increase oxygen flow overnight. Overnight desaturation was defined as ,90% for >30% of the night on either of two consecutive nights. HRQL was evaluated with the SF-36 Health Survey Questionnaire, Chronic Respiratory Questionnaire, and the Pittsburgh Sleep Quality Index. Results: Thirty eight patients (63% men) of mean (SD) age 73.5 (8.04) years and mean (SD) forced expiratory volume in 1 second 0.77 (0.35) l were evaluated. Overnight desaturation occurred in six (16%; 95% CI 4 to 27). Desaturators had mean (SD) resting oxygen saturation on room air of 88 (4.2)% compared with 90 (4.1)% in non-desaturators (p = 0.15), and corrected saturations of 93 (2.0)% versus 94 (2.0)% (p = 0.18). HRQL and sleep quality were poor but did not differ between desaturators and nondesaturators. Conclusions: Most patients did not exhibit overnight desaturation despite not increasing their LTOT prescription overnight. These results challenge the recommendation of routinely increasing overnight oxygen flow in patients receiving LTOT.