Characteristics at the time of oxygen initiation associated with its adherence: Findings from the COPD Long-term Oxygen Treatment Trial

Patient Use Patterns of Portable Oxygen Concentrators

INTRODUCTION

Portable oxygen concentrators (POCs) are medical devices that provide supplemental oxygen to patients requiring long-term oxygen therapy. However, little information is available on day-to-day patterns of how or even whether patients actively switch between their POC mobility features and flow setting options.

METHODS

A retrospective analysis was conducted to assess POC usage among patients who used an Inogen One G5 POC in the USA. This study aimed (1) to describe the patterns of use of POCs, (2) to analyze their compatibility with the prescribed oxygen therapy settings, and (3) to demonstrate the contribution of POC usage to get a standardized long-term oxygen therapy (LTOT). Data were directly downloaded from the devices returned for service or at the end of the Medicare Durable Medical Equipment rental period and streamed via a mobile application from 2018 to 2022. Daily usage, disconnections from the device, use of prescribed pulse delivery settings, breaths per minute, power sources, and movement with the POC were assessed. Device alert histories were also examined.

RESULTS

Data revealed a mean daily usage of 4.29 ± 3.23 h/day, ranging from 0.35 to 15.52 h/day. The prescribed pulse delivery setting was used by 31.34% of patients for at least 80% of their POC use time. When the POC was on battery power, patients were moving/mobile 41.99 ± 33.33% of the time. On the basis of the device-generated alerts, some patients continued to use their POC very close to or even beyond the lifetime of the column/sieve bed. Alerts or alarms potentially requiring repair occurred at a rate of 1.63 events per 100 years of use, indicating that device reliability did not significantly influence the use patterns.

CONCLUSION

Patients used their POCs when mobile and at rest. A large proportion of patients adjust their POC settings during the day, which potentially indicates the need for the dynamic individualization of oxygen dose delivery to match activities of daily living or sleep. Patients require follow-up to ensure timely replacement of POC columns.

Influence of ethnicity on adherence to nonsurgical interventions for COPD: a scoping review

Objective

Poor therapeutic adherence and the contributing factors have been extensively researched in several chronic diseases, including COPD. However, the influence of ethnicity on adherence to nonsurgical treatment interventions for COPD (e.g. smoking cessation and pulmonary rehabilitation) is not well understood. This scoping review was performed to better understand variations in adherence among people from minority ethnic communities diagnosed with COPD.

Method

This scoping review was designed based on the refined frameworks of Arksey and O'Malley, developed by JBI (Joanna Briggs Institute). Systematic searches were performed across three databases: CINHAL (EBSCO), MEDLINE (Ovid) and Embase (Ovid).

Results

Out of 3654 identified records, 37 studies were deemed eligible for inclusion; these were conducted in various countries and involved populations of diverse ethnic groups diagnosed with COPD. The included studies considered provision and/or adherence to medication (n=8, 21.6%), smoking cessation (n=11, 29.7%), influenza vaccinations (n=7, 18.9%), pulmonary rehabilitation (n=11, 29.7%) and oxygen therapy (n=2, 5.4%). Outcomes varied widely between studies within a single intervention (e.g. initiation, adherence and completion of pulmonary rehabilitation programme). However, most of the included studies suggested the presence of inequalities linked to ethnicity across interventions.

Conclusion

This review indicated the presence of poor adherence to nonsurgical interventions among people from minority ethnic backgrounds living with COPD. However, due to the heterogeneity in population groups considered and compared within the individual studies, it is challenging to identify and understand the key inequalities influencing adherence to nonsurgical interventions. Further research is needed to better explore this.

[Guideline for Long-Term Oxygen Therapy - S2k-Guideline Published by the German Respiratory Society]

Long-term oxygen therapy is of great importance both for reducing mortality and for improving performance in patients with chronic lung diseases. The prerequisites for Long-term oxygen therapy are adequate diagnostics and clearly defined indication. A causal distinction into chronic hypoxaemic and hypercapnic respiratory failure is reasonable, from which the differential indication for non-invasive ventilation results.The revised guideline covers the diagnostics and indication of chronic lung and heart diseases, the role of oxygen in terminal illness and gives a detailed description of available oxygen devices. The guideline is intended to help avoid undersupply, oversupply and false prescriptions. Furthermore, the chapter "Postacute Oxygen Therapy" discusses the procedure, relevant in everyday life, but not yet clearly defined, for prescribing oxygen therapy for the home at the end of an inpatient stay. Another important point, the correct prescription of mobile oxygen systems, is also presented in the guideline. This document is a revised version of the guideline for longterm oxygen therapy and replaces the version of 2008.

Celebration of the 50-Year Anniversary of the National Heart, Lung, and Blood Institute Division of Lung Diseases: A Half-Century of Landmark Clinical Trials

The National Institutes of Health (NIH)-National Heart, Lung, and Blood Institute's (NHLBI) Division of Lung Diseases is celebrating its 50th anniversary. On this occasion, we are reviewing the major landmark clinical trials that were initiated by the NHLBI's Division of Lung Disease and that have had substantial impact on our understanding of chronic obstructive pulmonary disease (COPD) and how it is best treated. Although some of these trials did not show hypothesized treatment benefits for COPD, they have enabled clinicians to provide care for individuals with COPD relying on the most rigorous evidence. The 5 trials that are reviewed here are: the Intermittent Positive Pressure Breathing Trial, the Nocturnal Oxygen Treatment Trial, the Lung Health Study, the National Emphysema Treatment Trial, and the Long-term Oxygen Treatment Trial. These clinical trials have not only set the standards for COPD care but have served as models for the state-of-the-art conduct of clinical research in COPD.

Clinician Strategies to Improve the Care of Patients Using Supplemental Oxygen

This article reviews four key clinician strategies to improve the care of adult patients receiving supplemental oxygen in the outpatient setting in the United States. The current barriers to adequate oxygen services are substantial and complex and include decreased reimbursement to durable medical equipment (DME) companies; a substantially lower number of available DME suppliers; difficult communication with DME suppliers; rigid patient testing, prescription, and documentation requirements; and unclear patient benefit and adherence. Recent data documenting frequent and varied problems reflect the significant impact of supplemental oxygen therapy on patients and caregivers. Areas where clinicians can improve patient oxygen experiences are highlighted in this review and include understanding Centers for Medicare and Medicaid Services oxygen prescription requirements, matching oxygen equipment to patient needs, providing essential patient education, and understanding mechanisms for patients and clinicians to report unresolved oxygen problems.