Automatic oxygen titration versus constant oxygen flow rates during walking in COPD: a randomised controlled, double-blind, crossover trial

Schneeberger, Tessa; Jarosch, Inga; Leitl, Daniela; Gloeckl, Rainer; Hitzl, Wolfgang; Dennis, C.; Geyer, T.; Criée, Carl-Peter; Koczulla, Andreas Rembert; Kenn, Klaus

doi:10.1136/thoraxjnl-2020-216509

Cited by 14 publications

(16 citation statements)

References 31 publications

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“…Therefore, ambulatory oxygen should primarily be limited to patients who exhibit and perceive a clinically relevant improvement in exercise tolerance or dyspnoea. According to two recent studies, the beneficial effects of portable oxygen on exercise capacity and dyspnoea may be further enhanced using automatically titrating oxygen systems, which regulate oxygen flow to maintain a predefined S pO 2 target during walking, when compared with the usually proposed oxygen supplementation via constant flow oxygen systems [ 50 , 51 ].…”

Section: Copd and Hypoxaemic Respiratory Failurementioning

confidence: 99%

Supplemental oxygen and noninvasive ventilation

2023

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The respiratory system attempts to maintain normal levels of oxygen and carbon dioxide. However, airflow limitation, parenchymal abnormalities and dysfunction of the respiratory pump may be compromised in individuals with advanced COPD, eventually leading to respiratory failure, with reduced arterial oxygen tension (hypoxaemia) and/or increased arterial carbon dioxide tension (PaCO2; hypercapnia). Hypoxaemia may persist in individuals with severe COPD despite smoking cessation and optimisation of pharmacotherapy. Long-term oxygen therapy (LTOT) can improve survival in those with severe daytime hypoxaemia, whereas those with less severe hypoxaemia may only have improved exercise capacity and dyspnoea. Changes in respiratory physiology that occur during sleep further predispose to hypoxaemia, particularly in individuals with COPD. However, the major cause of hypoxaemia is hypoventilation. Noninvasive ventilation (NIV) may reduce mortality and need for intubation in individuals with COPD and acute hypercapnic respiratory failure. However, NIV may also improve survival and quality of life in individuals with stable, chronic hypercapnia and is now suggested for those with prolonged hypercapnia (e.g.PaCO2>55 mmHg 2–6 weeks after hospital discharge) when clinically stable and after optimisation of medical therapy including LTOT if indicated. Many questions remain about the optimal mode, settings and goal of NIV therapy.

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Section: Copd and Hypoxaemic Respiratory Failurementioning

confidence: 99%

Supplemental oxygen and noninvasive ventilation

2023

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“…Closed-loop devices that deliver a variable dose of oxygen with a target saturation of 90–94% during exercise also represent an interesting approach that has recently been analyzed. Devices for automated oxygen administration (AOA) during exercise performed better than usual fixed-dose oxygen therapy, with a significant reduction in dyspnea and a significant increase in exercise endurance [19,20 ▪ ]. AOT may also have other benefits, such as facilitating peripheral muscle improvements through training, which is an important therapeutic target in COPD.…”

Section: Supplemental Oxygen Therapy For Exercise-induced Hypoxemiamentioning

confidence: 99%

Supplemental oxygen therapy in chronic obstructive pulmonary disease: is less is more? How much is too much?

Daher,

Dreher

2023

Current Opinion in Pulmonary Medicine

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Purpose of review Currently available evidence supporting the use of supplemental oxygen therapy (SOT) in chronic obstructive pulmonary disease (COPD) is complex, and data on the mortality reduction associated with SOT usage in patients with severe daytime resting hypoxemia have not been updated since the development of other treatments. Recent findings No reduction in mortality was found when SOT was used in patients with moderate resting daytime, isolated nocturnal, or exercise-induced hypoxemia. However, some of these patients obtain other significant benefits during SOT, including increased exercise endurance, and a mortality reduction is possible in these ‘responders’. The adverse effects of long-term oxygen therapy also need to be considered, such as reduced mobility and social stigma. Furthermore, conservative SOT could improve outcomes in the setting of COPD exacerbations compared with higher concentration oxygen regimens. Compared with usual fixed-dose SOT, automated oxygen administration devices might reduce dyspnea during exercise and COPD exacerbations. Summary Current recommendations for SOT need to be revised to focus on patients who respond best and benefit most from this therapy. A conservative approach to SOT can reduce side effects compared with higher concentration oxygen regimens, and automated oxygen administration devices may help to optimize SOT.

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“…(134) Considerando-se pacientes com DPOC grave a muito grave e com hipoxemia em repouso (n = 50), foi avaliada a suplementação de oxigênio por meio de um sistema de fluxo constante vs. titulação automática de oxigênio. (135) Essa última acarretou melhor oxigenação, maior tempo de endurance ao caminhar, maior oxigenação observada por SpO 2 e PaO 2 , menor sensação de dispneia e sem impacto na PaCO 2 . Os respondedores à titulação automática de oxigênio tenderam a apresentar menor valor de lactato, menos fadiga em membros inferiores no final do teste de endurance e menor sensação de dispneia.…”

Section: Dpocunclassified

“…Os respondedores à titulação automática de oxigênio tenderam a apresentar menor valor de lactato, menos fadiga em membros inferiores no final do teste de endurance e menor sensação de dispneia. (135) Já em relação ao treinamento com máscara de Venturi ou CN de alto fluxo (CNAF), ambos os grupos obtiveram benefícios do programa de treinamento físico com melhora significativa na capacidade de exercício, sintomas e qualidade de vida. (136) Numa revisão sistemática e meta-análise recente, na qual foram incluídos 7 estudos para a avaliação de oxigênio suplementar e RP, foi demonstrado que a suplementação de oxigênio durante a RP não melhorou a capacidade de exercício, os escores de dispneia ou a qualidade de vida, mas com a ressalva de nível de evidência fraca, principalmente pela intervenção heterogênea nos estudos.…”

Section: Dpocunclassified

2022 Brazilian Thoracic Association recommendations for long-term home oxygen therapy

et al. 2022

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Some chronic respiratory diseases can cause hypoxemia and, in such cases, long-term home oxygen therapy (LTOT) is indicated as a treatment option primarily to improve patient quality of life and life expectancy. Home oxygen has been used for more than 70 years, and support for LTOT is based on two studies from the 1980s that demonstrated that oxygen use improves survival in patients with COPD. There is evidence that LTOT has other beneficial effects such as improved cognitive function, improved exercise capacity, and reduced hospitalizations. LTOT is indicated in other respiratory diseases that cause hypoxemia, on the basis of the same criteria as those used for COPD. There has been an increase in the use of LTOT, probably because of increased life expectancy and a higher prevalence of chronic respiratory diseases, as well as greater availability of LTOT in the health care system. The first Brazilian Thoracic Association consensus statement on LTOT was published in 2000. Twenty-two years la-ter, we present this updated version. This document is a nonsystematic review of the literature, conducted by pulmonologists who evaluated scientific evidence and international guidelines on LTOT in the various diseases that cause hypoxemia and in specific situations (i.e., exercise, sleep, and air travel). These recommendations, produced with a view to clinical practice, contain several charts with information on indications for LTOT, oxygen sources, accessories, strategies for improved efficiency and effectiveness, and recommendations for the safe use of LTOT, as well as a LTOT prescribing model.

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Automatic oxygen titration versus constant oxygen flow rates during walking in COPD: a randomised controlled, double-blind, crossover trial

Cited by 14 publications

References 31 publications

Supplemental oxygen and noninvasive ventilation

Supplemental oxygen and noninvasive ventilation

Supplemental oxygen therapy in chronic obstructive pulmonary disease: is less is more? How much is too much?

2022 Brazilian Thoracic Association recommendations for long-term home oxygen therapy

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