Association between long-term oxygen therapy provided outside the guidelines and mortality in patients with COPD

IntroductionHypoxaemia is a frequent complication of chronic obstructive pulmonary disease (COPD). To prevent its consequences, supplemental oxygen therapy is recommended by international respiratory societies. However, despite clear recommendations, some patients receive long-term oxygen therapy (LTOT), while they do not meet prescription criteria. While evidence suggests that acute oxygen supply at high oxygenation targets increases COPD mortality, its chronic effects on COPD mortality remain unclear. Thus, the study will aim to evaluate through a systematic review and individual patient data meta-analysis (IPD-MA), the association of LTOT prescription outside the guidelines on survival over time in COPD.MethodsSystematic review and IPD-MA will be conducted according to Preferred Reporting Items for a Systematic Review and Meta-Analyses IPD guidelines. Electronic databases (PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, OpenGrey and BioRxiv/MedRxix) will be scanned to identify relevant studies (cohort of stable COPD with arterial oxygen tension data available, with indication of LTOT filled out at the moment of the study and with a survival follow-up). The anticipated search dates are January–February 2022. The main outcome will be the association between LTOT and time to all-cause mortality according to hypoxaemia severity, after controlling for potential covariates and all available clinical characteristics. Quantitative data at the level of the individual patient will be used in a one-step approach to develop and validate a prognostic model with a Cox regression analysis. The one-step IPD-MA will be conducted to study the association and the moderators of association between supplemental oxygen therapy and mortality. Multilevel survival analyses using Cox-mixed effects models will be performed.Ethics and disseminationAs a protocol for a systematic review, a formal ethics committee review is not required. Only studies with institutional approval from an ethics committee and anonymised IPD will be included. Results will be disseminated through peer-reviewed publications and presentations in conferences.PROSPERO registration numberCRD42020209823.

Dietary Behaviour and Nutrition in Patients with COPD Treated with Long-Term Oxygen Therapy

Background: It is the first study in Poland and one of the first in the world to assess the nutrition of patients with chronic obstructive pulmonary disease (COPD) treated with long-term oxygen therapy (LTOT). Methods: The study group consisted of 110 COPD patients treated with LTOT. Anthropometric measurements and spirometry were performed. The diet of patients was assessed using a 3-day nutrition diary. Results: When assessing the degree of airflow obstruction (FEV1% N) depending on the BMI in patients treated with LTOT, a statistically significant correlation was demonstrated between the BMI and the value of the FEV% N parameter (p = 0.0093). Patients with COPD with a BMI >30 had statistically significantly higher values of FEV1% N than patients with a BMI in the range of 20–24.9 (p = 0.0278). Intake of calcium, vitamins A, C, D, E and folates was lower than the recommended daily intake in more than 95% of COPD patients. Conclusions: The diet of COPD patients treated with long-term oxygen therapy was improperly balanced, with deficiencies of important nutrients. Airflow obstruction in the respiratory tract was significantly smaller in obese patients, and greater in patients with diagnosed malnutrition.

In Vitro Evaluation of a Nasal Interface Used to Improve Delivery from a Portable Oxygen Concentrator

Portable oxygen concentrators (POCs) are widely used to administer long-term oxygen therapy (LTOT) and employ pulsed delivery modes to conserve oxygen. Efficient pulsed delivery requires that POCs are triggered by patient inhalation. Triggering is known to fail for some patients during periods of quite breathing, as occurs during sleep. The present article describes a new nasal interface designed to improve triggering of pulsed oxygen delivery from portable oxygen concentrators (POCs). In vitro experiments incorporating realistic nasal airway replicas and simulated breathing were conducted. The pressure monitored via oxygen supply tubing (the signal pressure) was measured over a range of constant inhalation flow rates with the nasal interface inserted into the nares of the nasal airway replicas, and compared with signal pressures measured for standard and flared nasal cannulas. Triggering efficiency and the fraction of inhaled oxygen (FiO2) were then evaluated for the nasal interface and cannulas used with a commercial POC during simulated tidal breathing through the replicas. Higher signal pressures were achieved for the nasal interface than for nasal cannulas at all flow rates studied. The nasal interface triggered pulsed delivery from the POC in cases where nasal cannulas failed to trigger. FiO2 was significantly higher for successful triggering cases than for failed triggering cases. The nasal interface improved triggering of pulsed oxygen delivery from a POC and presents a simple solution that could be used with commercially-available POCs to reliably supply oxygen during periods of quiet breathing.

The Prevalance of Depression amongst People with Chronic Obstructive Pulmonary Disease on Long Term Oxygen Therapy

<p><b>Aim:To determine the prevalence of depression amongst people with chronic obstructive pulmonary disease (COPD) on long term oxygen therapy (LTOT) and examine the differences and relationships between depressed and not depressed patients to inform clinical practice.</b></p> <p>Methods:In September 2009 a cross-sectional point prevalence study of the total District Health Board (DHB) population of COPD patients on LTOT oxygen in a large urban area in New Zealand (NZ) was conducted. Depression was assessed using the self-completed Patient Health Questionnaire (PHQ-9). Additional clinical and demographic characteristics were obtained from hospital records and a self-completed questionnaire.</p> <p>Results:Sixty three patients (36 females, mean age 72) from the total population of 73 with severe COPD (forced expiratory volume in one second [FEV1] 37% predicted) completed the survey. PHQ-9 results indicate the total prevalence of depression was 54%; 95% CI 41.71-65.87. Twenty five percent of patients had mild depression and 29% had moderate to severe depression. One in six patients of those who screened positively was being treated for depression. No significant correlations or differences were found between the depressions scores and the demographic (age, gender, lives alone) or clinical (portable oxygen, time on oxygen, hospital admissions, pulmonary rehabilitation and FEV1) characteristics.</p> <p>Conclusion:This study provides new evidence regarding the prevalence of depression in NZ COPD LTOT populations. Depression symptoms and depression are highly prevalent in this patient population and there is evidence depression is undertreated. The PHQ-9 is a simple and effective tool community nurses can use for the initial screening of depression, which could improve the recognition and possible uptake of effective interventions to lessen the impact of depression in this population. The PHQ-9 is validated screening tool that should be used in further depression prevalence research with NZ COPD and other long-term condition populations to determine homogeneity across studies.</p>

The Prevalance of Depression amongst People with Chronic Obstructive Pulmonary Disease on Long Term Oxygen Therapy

<p><b>Aim:To determine the prevalence of depression amongst people with chronic obstructive pulmonary disease (COPD) on long term oxygen therapy (LTOT) and examine the differences and relationships between depressed and not depressed patients to inform clinical practice.</b></p> <p>Methods:In September 2009 a cross-sectional point prevalence study of the total District Health Board (DHB) population of COPD patients on LTOT oxygen in a large urban area in New Zealand (NZ) was conducted. Depression was assessed using the self-completed Patient Health Questionnaire (PHQ-9). Additional clinical and demographic characteristics were obtained from hospital records and a self-completed questionnaire.</p> <p>Results:Sixty three patients (36 females, mean age 72) from the total population of 73 with severe COPD (forced expiratory volume in one second [FEV1] 37% predicted) completed the survey. PHQ-9 results indicate the total prevalence of depression was 54%; 95% CI 41.71-65.87. Twenty five percent of patients had mild depression and 29% had moderate to severe depression. One in six patients of those who screened positively was being treated for depression. No significant correlations or differences were found between the depressions scores and the demographic (age, gender, lives alone) or clinical (portable oxygen, time on oxygen, hospital admissions, pulmonary rehabilitation and FEV1) characteristics.</p> <p>Conclusion:This study provides new evidence regarding the prevalence of depression in NZ COPD LTOT populations. Depression symptoms and depression are highly prevalent in this patient population and there is evidence depression is undertreated. The PHQ-9 is a simple and effective tool community nurses can use for the initial screening of depression, which could improve the recognition and possible uptake of effective interventions to lessen the impact of depression in this population. The PHQ-9 is validated screening tool that should be used in further depression prevalence research with NZ COPD and other long-term condition populations to determine homogeneity across studies.</p>

The Prevalance of Depression amongst People with Chronic Obstructive Pulmonary Disease on Long Term Oxygen Therapy

<p>Aim: To determine the prevalence of depression amongst people with chronic obstructive pulmonary disease (COPD) on long term oxygen therapy (LTOT) and examine the differences and relationships between depressed and not depressed patients to inform clinical practice. Methods: In September 2009 a cross-sectional point prevalence study of the total District Health Board (DHB) population of COPD patients on LTOT oxygen in a large urban area in New Zealand (NZ) was conducted. Depression was assessed using the self-completed Patient Health Questionnaire (PHQ-9). Additional clinical and demographic characteristics were obtained from hospital records and a self-completed questionnaire. Results: Sixty three patients (36 females, mean age 72) from the total population of 73 with severe COPD (forced expiratory volume in one second [FEV1] 37% predicted) completed the survey. PHQ-9 results indicate the total prevalence of depression was 54%; 95% CI 41.71-65.87. Twenty five percent of patients had mild depression and 29% had moderate to severe depression. One in six patients of those who screened positively was being treated for depression. No significant correlations or differences were found between the depressions scores and the demographic (age, gender, lives alone) or clinical (portable oxygen, time on oxygen, hospital admissions, pulmonary rehabilitation and FEV1) characteristics. Conclusion: This study provides new evidence regarding the prevalence of depression in NZ COPD LTOT populations. Depression symptoms and depression are highly prevalent in this patient population and there is evidence depression is undertreated. The PHQ-9 is a simple and effective tool community nurses can use for the initial screening of depression, which could improve the recognition and possible uptake of effective interventions to lessen the impact of depression in this population. The PHQ-9 is validated screening tool that should be used in further depression prevalence research with NZ COPD and other long-term condition populations to determine homogeneity across studies.</p>