This review aims to establish the impact of oxygen therapy on dyspnoea, health-related quality of life (HRQoL), exercise capacity and mortality in interstitial lung disease (ILD).We included studies that compared oxygen therapy to no oxygen therapy in adults with ILD. No limitations were placed on study design or intervention type. Two reviewers independently evaluated studies for inclusion, assessed risk of bias and extracted data. The primary outcome was dyspnoea.Eight studies evaluated the acute effects of oxygen (n=1509). There was no effect of oxygen therapy on modified Borg dyspnoea score at end exercise (mean difference (MD) -0.06 units, 95% CI -0.24-0.13; two studies, n=27). However, effects on exercise outcomes consistently favoured oxygen therapy. One study showed reduction in dyspnoea at rest with oxygen in patients who were acutely unwell (MD visual analogue scale 30 mm 48 mm, p<0.05; n=10). Four studies of long-term oxygen therapy (n=2670) had high risk of bias and no inferences could be drawn.This systematic review showed no effects of oxygen therapy on dyspnoea during exercise in ILD, although exercise capacity was increased. Future trials should evaluate whether acute improvements in exercise capacity with oxygen can be translated into improved physical activity and HRQoL.

BackgroundPeople with pulmonary fibrosis often experience a protracted time to diagnosis, high symptom burden and limited disease information. This review aimed to identify the supportive care needs reported by people with pulmonary fibrosis and their caregivers.MethodsA systematic review was conducted according to PRISMA guidelines. Studies that investigated the supportive care needs of people with pulmonary fibrosis or their caregivers were included. Supportive care needs were extracted and mapped to eight pre-specified domains using a framework synthesis method.ResultsA total of 35 studies were included. The most frequently reported needs were in the domain of information/education, including information on supplemental oxygen, disease progression and prognosis, pharmacological treatments and end-of-life planning. Psychosocial/emotional needs were also frequently reported, including management of anxiety, anger, sadness and fear. An additional domain of “access to care” was identified that had not been specified a priori; this included access to peer support, psychological support, specialist centres and support for families of people with pulmonary fibrosis.ConclusionPeople with pulmonary fibrosis report many unmet needs for supportive care, particularly related to insufficient information and lack of psychosocial support. These data can inform the development of comprehensive care models for people with pulmonary fibrosis and their loved ones.

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We have recently shown that anxiety and depression are common comorbidities for people with interstitial lung disease (ILD). In a cross-sectional single-centre study, the prevalence of anxiety was 31% and the prevalence of depression was 23% [1]. Anxiety and depression were not related to physiological parameters; however, dyspnoea and number of comorbidities were important contributors. The aims of this study were to determine the frequency of prolonged anxiety and depression among sufferers of idiopathic pulmonary fibrosis (IPF), and factors contributing to their persistence.Using the Australian IPF Registry, we obtained data from all individuals who had completed the self-reported Hospital Anxiety and Depression Scale (HADS) at baseline and at 12 months of follow-up [2,3]. HADS scores were classified according to standard criteria where a score >10 indicates a probable case of clinically significant anxiety or depression and a score of 8-10 indicates borderline probability. We defined prolonged anxiety and depression as being present when subjects had HADS scores ⩾8 at baseline and at 12 months follow-up. We defined worsening risk of anxiety and depression as moving from "no case" to "borderline" or "case", or moving from "borderline" to "case", at 12 months.Analysis included demographic and physiologic data, and patient-reported medical comorbidities. Breathlessness was measured using the UCSD shortness of breath questionnaire (UCSDSOBQ) which, like the HADS scale, explores symptoms over the preceding week [4]. Cough severity was rated using an unvalidated visual analogue scale (VAS), measured between 0 and 100 mm, with anchors of "no cough" and "worst cough imaginable" The persistence of anxiety and depression over 12 months of follow-up was evaluated using the Fisher's exact test. Univariate relationships were tested using Pearson's Chi-squared test for categorical variables and one-way analysis of variance for continuous variables. Variables with a relationship to prolonged anxiety or depression ( p<0.1) were entered into a logistic regression model. Model fit and the proportion of participants correctly classified by the model were evaluated using the Chi-squared test.

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