The Debate on Continuous Home Oxygen Therapy

Portable Oxygen Therapy: Is the 6-Minute Walking Test Overestimating the Actual Oxygen Needs?

The appropriate titration for the personalized oxygen needs of patients with chronic obstructive pulmonary disease (COPD) and severe hypoxemia is a determining factor in the success of long-term oxygen therapy. There are no standardized procedures to assist in determining the patient’s needs during the physical activities of daily life. Despite that effort tests are a wide broad approach, further research concerning the development of protocols to titrate O₂ therapy is needed. The main objective of this study was to assess whether the level of oxygen titrated through the 6-minute walking test (6MWT) for patients with COPD and exertional hypoxemia is adequate to meet the patients’ demand during their activities of daily living. Physiological and subjective variables were estimated for a study population during two walking tests: a 6MWT and a 20-minute walking circuit (20MWC), designed ad-hoc to reproduce daily physical activities more truthfully. The results indicate that in a significant proportion of patients, the 6MWT might not accurately predict their oxygen needs at a domiciliary environment. Therefore, the titration of the portable O₂ therapy could not be optimal in these cases, with the detrimental impact on the patient’s health (hyperoxia episodes), the autonomy of the oxygen device, and the decrease of time out of the home.

Oxygen devices and delivery systems

Oxygen use has extended from inpatient to outpatient settings for patients with chronic pulmonary diseases and complications of hypoxaemia. This article presents an overview of oxygen devices (oxygen concentrators, compressed gas cylinders and liquid oxygen) and delivery systems (high- and low-flow). The indications, advantages and disadvantages of each device and delivery system are presented, aiming to offer updated knowledge to the multidisciplinary team members managing patients with respiratory failure, and therefore allowing appropriate selection of devices and delivery systems that are tailored to the needs of each patient.

A telephone-based survey of current trends, habits and beliefs in patients receiving portable oxygen therapy in Madrid, Spain

Portable oxygen therapy is a major challenge for patients and clinicians. Additionally, the available evidence on this subject is poor considering that only a few studies have been published and the results have not been encouraging. We explored the current trends, habits and beliefs among patients receiving portable oxygen therapy in a geographical area of Madrid, Spain (4 051 862 inhabitants). A telephone-based survey was conducted among patients selected from a database who were undergoing portable oxygen therapy. The number of patients on home respiratory therapies on December 31, 2017 was 81 559 (prevalence 2013.30 per 100 000 inhabitants). A total of 19 492 patients were on home oxygen therapy (HOT) (prevalence 481.16 per 100 000 inhabitants). Of these, 4015 patients (20% of the total of patients on HOT) received ambulatory oxygen therapy. In the analysed period, 1942 patients were selected (57.31% male and 42.69% female). The mean±sd age was 73.89±11.67 years. Most of patients had portable oxygen concentrators (99.59%). The survey was completed by 1777 patients. Most of patients thought they had been prescribed HOT for respiratory failure. 55% of the participants surveyed reported having carried out a walking test with oxygen to know the amount of oxygen they needed. 71% of the participants reported leaving the home for between 1 and 3 h a day. Most of them were carrying portable devices in a wheeled cart (51.94%). Our study data obtained from a large sample of oxygen-dependent individuals provide valuable information regarding domiciliary and portable oxygen usage in Madrid.

Home oxygen therapy: re-thinking the role of devices

INTRODUCTION

A range of devices are available for delivering and monitoring home oxygen therapy (HOT). Guidelines do not give indications for the choice of the delivery device but recommend the use of an ambulatory system in subjects on HOT whilst walking. Areas covered: We provide a clinical overview of HOT and review traditional and newer delivery and monitoring devices for HOT. Despite relevant technology advancements, clinicians, faced with many challenges when they prescribe oxygen therapy, often remain familiar to traditional devices and continuous flow delivery of oxygen. Some self-filling delivery-less devices could increase the users' level of independence with ecological advantage and, perhaps, reduced cost. Some newer portable oxygen concentrators are being available, but more work is needed to understand their performances in different diseases and clinical settings. Pulse oximetry has gained large diffusion worldwide and some models permit long-term monitoring. Some closed-loop portable monitoring devices are also able to adjust oxygen flow automatically in accordance with the different needs of everyday life. This might help to improve adherence and the practice of proper oxygen titration that has often been omitted because difficult to perform and time-consuming. Expert commentary: The prescribing physicians should know the characteristics of newer devices and use technological advancements to improve the practice of HOT.