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Yang J, Steffens A, Olson AL, Anderson A, Basra G, Veeranki P, de Andrade JA. Supplemental oxygen therapy use among patients with fibrosing interstitial lung disease in the United States. Respir Res 2025; 26:80. [PMID: 40022082 PMCID: PMC11871663 DOI: 10.1186/s12931-025-03139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 02/06/2025] [Indexed: 03/03/2025] Open
Abstract
BACKGROUND Supplemental oxygen therapy is commonly prescribed in clinical practice for patients with fibrosing interstitial lung disease (ILD) to reduce breathlessness and increase physical capacity. Only a few studies have evaluated the incidence of oxygen therapy use, with evidence lacking in its use among fibrosing ILD subtypes including patients with idiopathic pulmonary fibrosis (IPF) and non-IPF ILD. This study aimed to estimate incidence of oxygen therapy and factors associated with oxygen therapy initiation. METHODS This non-interventional study used US administrative claims and electronic health record data from 01 October 2015 to 30 June 2022. Patients aged ≥ 18 years with newly diagnosed fibrosing ILD (≥ 2 fibrosing ILD diagnoses in any position on different dates of service within 365 days) were included; the index date was the first date with ILD diagnosis. Patients were followed until the earlier of health plan disenrollment, death, or end of study period. Oxygen therapy use was evaluated among patients without evidence of oxygen therapy before the index date, stratified by the underlying fibrosing disease (i.e., IPF vs. non-IPF ILD). Factors associated with oxygen therapy use were evaluated using Cox proportional hazards regression. RESULTS A total of 114,921 patients (IPF n = 5,555; non-IPF ILD n = 109,366) newly diagnosed with fibrosing ILD were included in the study. The mean (standard deviation) age of patients with ILD was 66.9 (14.2) years, and 47.2% were male. Patients were followed for a mean of 24 months after ILD diagnosis, during which 38% of fibrosing ILD patients initiated oxygen therapy; a higher proportion of patients with IPF initiated oxygen therapy compared to those with non-IPF ILD (68% and 36%, respectively). Factors associated with oxygen therapy initiation included IPF, higher Charlson comorbidity scores, and comorbidities that impair respiratory capacity. CONCLUSIONS The study findings demonstrate a substantial proportion of patients with fibrosing ILD initiated oxygen therapy following initial ILD diagnosis, with higher rates of oxygen therapy initiation observed among patients with IPF compared with non-IPF ILD. Respiratory comorbidities were key factors associated with increased initiation of oxygen therapy.
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Affiliation(s)
- Joseph Yang
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA.
| | | | - Amy L Olson
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
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Polverino F, Bhutani M, Zabert G, Fernandes FLA, Czischke K, Pereira Ferreira LF, Szabo L, Wisnivesky JP, Dalcolmo MP, Celedón JC. Access to Treatment for Chronic Obstructive Pulmonary Disease in the Americas: A Call for Action. A Joint Perspective from the Brazilian Thoracic Society, Canadian Thoracic Society, Latin American Thoracic Society, and the American Thoracic Society. Ann Am Thorac Soc 2024; 21:1463-1470. [PMID: 39083678 PMCID: PMC11568495 DOI: 10.1513/annalsats.202404-386fr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/31/2024] [Indexed: 08/02/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a major public health problem in the Americas (a region of the world comprising North, Central, and South America), although there is substantial variation in disease prevalence, morbidity, and mortality between and within nations. Across the Americas, COPD disproportionately affects vulnerable populations, including minoritized populations and impoverished persons, who are more likely to be exposed to risk factors such as tobacco use, air pollution, infections such as tuberculosis, and biomass smoke, but less likely to have adequate healthcare access. Management of COPD can be challenging across the Americas, with some barriers being specific to certain countries and others shared across the United States, Canada, and Latin America. Because most cases of COPD are undiagnosed because of suboptimal access to health care and pulmonary function testing and, thus, cannot be treated, increased access to spirometry would have a substantial impact on disease management across the Americas. For individuals who are diagnosed, access to medications and other interventions is quite variable across and within nations, even in those with universal healthcare systems, such as Canada and Brazil. This emphasizes the importance of collaborative treatment guidelines, which should be adapted for the healthcare systems and policies of each nation or region, as appropriate. To have a positive impact on COPD management in the Americas, we propose actionable items, including the need for all our respiratory societies to engage key stakeholders (e.g., patient-led organizations, professional societies, and governmental and nongovernmental agencies) while advocating for campaigns and policies to ensure clean air for all; eliminate tobacco use and enhance coverage for treatment of nicotine dependence; and improve access to early case finding, diagnosis, and treatment for all patients, including underserved and vulnerable populations.
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Affiliation(s)
- Francesca Polverino
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Mohit Bhutani
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Gustavo Zabert
- Clínica Pasteur, Universidad Nacional de Comahue, Neuquen, Argentina
| | - Frederico Leon Arrabal Fernandes
- Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Karen Czischke
- Departmento de Medicina Pulmonar, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | | | - Lian Szabo
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Juan P. Wisnivesky
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Juan C. Celedón
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Khor YH, Ekström M. The benefits and drawbacks of home oxygen therapy for COPD: what's next? Expert Rev Respir Med 2024; 18:469-483. [PMID: 38984511 DOI: 10.1080/17476348.2024.2379459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/09/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Home oxygen therapy is one of the few interventions that can improve survival in patients with chronic obstructive pulmonary disease (COPD) when administered appropriately, although it may cause side effects and be an unnecessary burden for some patients. AREAS COVERED This narrative review summarizes the current literature on the assessment of hypoxemia, different types of home oxygen therapy, potential beneficial and adverse effects, and emerging research on home oxygen therapy in COPD. A literature search was performed using MEDLINE and EMBASE up to January 2024, with additional articles being identified through clinical guidelines. EXPERT OPINION Hypoxemia is common in patients with more severe COPD. Long-term oxygen therapy is established to prolong survival in patients with chronic severe resting hypoxemia. Conversely, in the absence of chronic severe resting hypoxemia, home oxygen therapy has an unclear or conflicting evidence base, including for palliation of breathlessness, and is generally not recommended. However, beneficial effects in some patients cannot be precluded. Evidence is emerging on the optimal daily duration of oxygen use, the role of high-flow and auto-titrated oxygen therapy, improved informed decision-making, and telemonitoring. Further research is needed to validate novel oxygen delivery systems and monitoring tools and establish long-term effects of ambulatory oxygen therapy in COPD.
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Affiliation(s)
- Yet H Khor
- Respiratory Research@Alfred, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Magnus Ekström
- Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Gosselin C, Côté M, Tremblay L, Lacasse Y. Use of Palliative Oxygen in Cancer Patients. Am J Hosp Palliat Care 2023; 40:1087-1092. [PMID: 36452992 PMCID: PMC10507986 DOI: 10.1177/10499091221144005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background: Despite the lack of evidence to support the use of palliative oxygen to relieve dyspnea at the end of life, its prescription is widespread and often supported by local and national practice guidelines. Objectives: The objectives of this study were (1) to determine to what extent oxygen prescriptions meet the proposed prescription criteria in our institution, (2) to examine the indication of individual prescriptions in relation to the severity of dyspnea and (3) to review the utilization of opioids in patients receiving palliative oxygen. Methods: Retrospective chart review of cancer patients who were prescribed palliative oxygen between April 2015 and January 2020 through a respiratory home care program in Quebec City, Canada. According to provincial prescription guidelines, palliative oxygen was provided and reimbursed in case of severe hypoxemia (pulse oximetry saturation at rest < 88%) in cancer patients with an estimated prognosis of less than 3 months. Results: 134 patients receiving palliative oxygen were included; 25 (19%) did not fulfill reimbursement criteria. Median survival was 44 days. At initiation of palliative oxygen, 48 patients (36%) had only mild or moderate dyspnea (Medical Research Council dyspnea score 1-3), 26 (19%) did not receive opioids, and 9 (7%) were prescribed palliative oxygen without being dyspneic or receiving opioids. Conclusion: Most prescriptions of palliative oxygen met the proposed prescription criteria in our institution. Half of those who received palliative oxygen were only mildly dyspneic and/or were not receiving opioids at the time of the prescription.
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Affiliation(s)
- Caroline Gosselin
- Centre de Recherche, Université Laval, Institut universitaire de Cardiologie et de Pneumologie de Québec, QC, Canada
| | - Mélanie Côté
- Centre de Recherche, Université Laval, Institut universitaire de Cardiologie et de Pneumologie de Québec, QC, Canada
| | - Lise Tremblay
- Centre de Recherche, Université Laval, Institut universitaire de Cardiologie et de Pneumologie de Québec, QC, Canada
| | - Yves Lacasse
- Centre de Recherche, Université Laval, Institut universitaire de Cardiologie et de Pneumologie de Québec, QC, Canada
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Saleem F, Hur SA, Cahalan M, Stewart C, Sljivic I, Bhuiyan I, Aulakh A, Fleetham J, Guenette J, Ryerson C. International guideline recommendations and eligibility criteria for home oxygen therapy. THE LANCET. RESPIRATORY MEDICINE 2023; 11:402-405. [PMID: 36966792 DOI: 10.1016/s2213-2600(23)00100-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/03/2023] [Accepted: 02/12/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Ferhan Saleem
- Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - Seo Am Hur
- Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - Mark Cahalan
- Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - Caelie Stewart
- Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - Igor Sljivic
- Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - Ishmam Bhuiyan
- Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - Arshbir Aulakh
- Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - John Fleetham
- Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada; Home Oxygen Program, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Jordan Guenette
- Department of Respiratory Medicine, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada
| | - Christopher Ryerson
- Department of Medicine, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada; Department of Respiratory Medicine, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada.
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Castellano MVCDO, Pereira LFF, Feitosa PHR, Knorst MM, Salim C, Rodrigues MM, Ferreira EVM, Duarte RLDM, Togeiro SM, Stanzani LZL, Medeiros Júnior P, Schelini KNDM, Coelho LS, Sousa TLFD, Almeida MBD, Alvarez AE. 2022 Brazilian Thoracic Association recommendations for long-term home oxygen therapy. J Bras Pneumol 2022; 48:e20220179. [PMID: 36350954 PMCID: PMC9747190 DOI: 10.36416/1806-3756/e20220179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
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 later, 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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Affiliation(s)
| | | | | | - Marli Maria Knorst
- . Faculdade de Medicina, Universidade Federal do Rio Grande do Sul -UFRGS - Porto Alegre (RS) Brasil
- . Hospital de Clínicas de Porto Alegre - HCPA - Porto Alegre (RS) Brasil
| | - Carolina Salim
- . AC Camargo Cancer Center, São Paulo (SP) Brasil
- . Hospital da Polícia Militar de São Paulo, São Paulo (SP) Brasil
| | | | | | | | - Sonia Maria Togeiro
- . Disciplina de Clínica Médica e Medicina Laboratorial, Universidade Federal de São Paulo - Unifesp - São Paulo (SP), Brasil
| | | | | | | | - Liana Sousa Coelho
- . Universidade Estadual Julio de Mesquita Filho - UNESP - Botucatu (SP) Brasil
| | - Thiago Lins Fagundes de Sousa
- . Hospital Universitário Alcides Carneiro, Universidade Federal de Campina Grande - HUAC/UFCG - Campina Grande (PB) Brasil
| | | | - Alfonso Eduardo Alvarez
- . Departamento de Pneumologia, Sociedade de Pediatria de São Paulo - SPSP - Campinas (SP) Brasil
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Lacasse Y, Bernard S, Maltais F, Nguyen VH. Cost-Effectiveness of an Extended Home Visit Program for Oxygen-Dependent COPD Patients. Respir Care 2022; 67:1082-1090. [PMID: 35728823 PMCID: PMC9994336 DOI: 10.4187/respcare.09781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Long-term oxygen therapy in COPD is usually supervised through home-care respiratory programs. Such programs often involve an intensive education intervention at the initiation of long-term oxygen therapy, followed by an extended follow-up period that aims toward home oxygen adherence. The objective of this study was to estimate the cost-effectiveness ratio of such a maintenance program. METHODS A simulation model was developed that compared 2 strategies after the intensive education intervention: (1) enrollment and (2) no enrollment in a maintenance program. The study population consisted of a hypothetical cohort of 200 patients (100 patients per group; mean age, 74 years; 45% men; mean FEV1 of 43% predicted value; and mean resting PaO2 while breathing air, 50 mm Hg). Effectiveness assumptions of the program were derived from a current literature review. The primary outcome was the ratio of the incremental cost of the program per quality-adjusted life-years gained. Only direct costs were considered; a health-care system perspective was adopted. Costs are reported in 2020 Canadian dollars (Can $). RESULTS Over a 5-year period, an extended home-visit program may prevent 9 deaths and provide an additional 39 years of life and 24 quality-adjusted life-years. Compared with usual care (ie, no enrollment in the maintenance program), the incremental cost-effectiveness ratio was Can $17,197 per quality-adjusted life-years gained. Sensitivity analyses demonstrated the robustness of the model. Only a reduction in adherence of 25% per year would increase the incremental cost-effectiveness ratio per quality-adjusted life-years beyond the threshold of Can $50,000 that is usually considered as acceptable from a health-care system perspective. CONCLUSIONS An extended home-visit program to maintain or improve adherence to long-term oxygen therapy in patients with COPD would most likely be cost-effective.
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Affiliation(s)
- Yves Lacasse
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, Québec, Québec, Canada.
| | - Sarah Bernard
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, Québec, Québec, Canada
| | - François Maltais
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, Québec, Québec, Canada
| | - Van Hung Nguyen
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval, Québec, Québec, Canada
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Tang M, Mehrotra A, Stern AD. Rapid Growth Of Remote Patient Monitoring Is Driven By A Small Number Of Primary Care Providers. Health Aff (Millwood) 2022; 41:1248-1254. [PMID: 36067430 DOI: 10.1377/hlthaff.2021.02026] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Growing enthusiasm for remote patient monitoring has been motivated by the hope that it can improve care for patients with poorly controlled chronic illness. In a national commercially insured population in the US, we found that billing for remote patient monitoring increased more than fourfold during the first year of the COVID-19 pandemic. Most of this growth was driven by a small number of primary care providers. Among the patients of these providers with a high volume of remote patient monitoring, we did not observe substantial targeting of remote patient monitoring to people with greater disease burden or worse disease control. Further research is needed to identify which patients benefit from remote patient monitoring, to inform evidence-based use and coverage decisions. In the meantime, payers and policy makers should closely monitor remote patient monitoring use and spending.
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Affiliation(s)
- Mitchell Tang
- Mitchell Tang, Harvard University, Boston, Massachusetts
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9
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Lacasse Y, Thériault S, St-Pierre B, Bernard S, Sériès F, Bernatchez HJ, Maltais F. Oximetry neither to prescribe long-term oxygen therapy nor to screen for severe hypoxaemia. ERJ Open Res 2021; 7:00272-2021. [PMID: 34671670 PMCID: PMC8521391 DOI: 10.1183/23120541.00272-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/23/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Transcutaneous pulse oximetry saturation (S pO2 ) is widely used to diagnose severe hypoxaemia and to prescribe long-term oxygen therapy (LTOT) in COPD. This practice is not based on evidence. The primary objective of this study was to determine the accuracy (false positive and false negative rates) of oximetry for prescribing LTOT or for screening for severe hypoxaemia in patients with COPD. METHODS In a cross-sectional study, we correlated arterial oxygen saturation (S aO2 ) and S pO2 in patients with COPD and moderate hypoxaemia (n=240) and calculated the false positive and false negative rates of S aO2 at the threshold of ≤88% to identify severe hypoxaemia (arterial oxygen tension (P aO2 ) ≤55 mmHg or P aO2 <60 mmHg) in 452 patients with COPD with moderate or severe hypoxaemia. RESULTS The correlation between S aO2 and S pO2 was only moderate (intra-class coefficient of correlation: 0.43; 95% confidence interval: 0.32-0.53). LTOT would be denied in 40% of truly hypoxaemic patients on the basis of a S aO2 >88% (i.e., false negative result). Conversely, LTOT would be prescribed on the basis of a S aO2 ≤88% in 2% of patients who would not qualify for LTOT (i.e., false positive result). Using a screening threshold of ≤92%, 5% of severely hypoxaemic patients would not be referred for further evaluation. CONCLUSIONS Several patients who qualify for LTOT would be denied treatment using a prescription threshold of saturation ≤88% or a screening threshold of ≤92%. Prescription of LTOT should be based on P aO2 measurement.
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Affiliation(s)
- Yves Lacasse
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, Canada
- Respiratory Home Care Programme, Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, Canada
| | - Sébastien Thériault
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, Canada
- Dept of Molecular Biology, Medical Biochemistry and Pathology, Université Laval, Québec, Canada
| | - Benoît St-Pierre
- Respiratory Home Care Programme, Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, Canada
| | - Sarah Bernard
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, Canada
| | - Frédéric Sériès
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, Canada
| | - Harold Jean Bernatchez
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, Canada
| | - François Maltais
- Research Center, Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, Canada
- Respiratory Home Care Programme, Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, Canada
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Aronson KI, Danoff SK, Russell AM, Ryerson CJ, Suzuki A, Wijsenbeek MS, Bajwah S, Bianchi P, Corte TJ, Lee JS, Lindell KO, Maher TM, Martinez FJ, Meek PM, Raghu G, Rouland G, Rudell R, Safford MM, Sheth JS, Swigris JJ. Patient-centered Outcomes Research in Interstitial Lung Disease: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2021; 204:e3-e23. [PMID: 34283696 PMCID: PMC8650796 DOI: 10.1164/rccm.202105-1193st] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: In the past two decades, many advances have been made to our understanding of interstitial lung disease (ILD) and the way we approach its treatment. Despite this, many questions remain unanswered, particularly those related to how the disease and its therapies impact outcomes that are most important to patients. There is currently a lack of guidance on how to best define and incorporate these patient-centered outcomes in ILD research. Objectives: To summarize the current state of patient-centered outcomes research in ILD, identify gaps in knowledge and research, and highlight opportunities and methods for future patient-centered research agendas in ILD. Methods: An international interdisciplinary group of experts was assembled. The group identified top patient-centered outcomes in ILD, reviewed available literature for each outcome, highlighted important discoveries and knowledge gaps, and formulated research recommendations. Results: The committee identified seven themes around patient-centered outcomes as the focus of the statement. After a review of the literature and expert committee discussion, we developed 28 research recommendations. Conclusions: Patient-centered outcomes are key to ascertaining whether and how ILD and interventions used to treat it affect the way patients feel and function in their daily lives. Ample opportunities exist to conduct additional work dedicated to elevating and incorporating patient-centered outcomes in ILD research.
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Holland AE, Corte T, Chambers DC, Palmer AJ, Ekström MP, Glaspole I, Goh NSL, Hepworth G, Khor YH, Hoffman M, Vlahos R, Sköld M, Dowman L, Troy LK, Prasad JD, Walsh J, McDonald CF. Ambulatory oxygen for treatment of exertional hypoxaemia in pulmonary fibrosis (PFOX trial): a randomised controlled trial. BMJ Open 2020; 10:e040798. [PMID: 33318119 PMCID: PMC7737108 DOI: 10.1136/bmjopen-2020-040798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Interstitial lung diseases are characterised by scarring of lung tissue that leads to reduced transfer of oxygen into the blood, decreased exercise capacity and premature death. Ambulatory oxygen therapy may be used to treat exertional oxyhaemoglobin desaturation, but there is little evidence to support its efficacy and there is wide variation in clinical practice. This study aims to compare the clinical efficacy and cost-effectiveness of ambulatory oxygen versus ambulatory air in people with fibrotic interstitial lung disease and exertional desaturation. METHODS AND ANALYSIS A randomised, controlled trial with blinding of participants, clinicians and researchers will be conducted at trial sites in Australia and Sweden. Eligible participants will be randomised 1:1 into two groups. Intervention participants will receive ambulatory oxygen therapy using a portable oxygen concentrator (POC) during daily activities and control participants will use an identical POC modified to deliver air. Outcomes will be assessed at baseline, 3 months and 6 months. The primary outcome is change in physical activity measured by number of steps per day using a physical activity monitor (StepWatch). Secondary outcomes are functional capacity (6-minute walk distance), health-related quality of life (St George Respiratory Questionnaire, EQ-5D-5L and King's Brief Interstitial Lung Disease Questionnaire), breathlessness (Dyspnoea-12), fatigue (Fatigue Severity Scale), anxiety and depression (Hospital Anxiety and Depression Scale), physical activity level (GENEActive), oxygen saturation in daily life, POC usage, and plasma markers of skeletal muscle metabolism, systematic inflammation and oxidative stress. A cost-effectiveness evaluation will also be undertaken. ETHICS AND DISSEMINATION Ethical approval has been granted in Australia by Alfred Hospital Human Research Ethics Committee (HREC/18/Alfred/42) with governance approval at all Australian sites, and in Sweden (Lund Dnr: 2019-02963). The results will be published in peer-reviewed scientific journals, presented at conferences and disseminated to consumers in publications for lay audiences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03737409).
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Affiliation(s)
- Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
| | - Tamera Corte
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel C Chambers
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
- School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Andrew J Palmer
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
- Health Economics Research Group, Menzies Institute for Medical Research, The University of Tasmania, Hobart, Tasmania, Australia
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Magnus Per Ekström
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Ian Glaspole
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Nicole S L Goh
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Yet H Khor
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Mariana Hoffman
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ross Vlahos
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Melbourne, Australia
| | - Magnus Sköld
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Leona Dowman
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia
| | - Lauren K Troy
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Jyotika D Prasad
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - James Walsh
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
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12
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Jacobs SS, Krishnan JA, Lederer DJ, Ghazipura M, Hossain T, Tan AYM, Carlin B, Drummond MB, Ekström M, Garvey C, Graney BA, Jackson B, Kallstrom T, Knight SL, Lindell K, Prieto-Centurion V, Renzoni EA, Ryerson CJ, Schneidman A, Swigris J, Upson D, Holland AE. Home Oxygen Therapy for Adults with Chronic Lung Disease. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 202:e121-e141. [PMID: 33185464 PMCID: PMC7667898 DOI: 10.1164/rccm.202009-3608st] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Evidence-based guidelines are needed for effective delivery of home oxygen therapy to appropriate patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD).Methods: The multidisciplinary panel created six research questions using a modified Delphi approach. A systematic review of the literature was completed, and the Grading of Recommendations Assessment, Development and Evaluation approach was used to formulate clinical recommendations.Recommendations: The panel found varying quality and availability of evidence and made the following judgments: 1) strong recommendations for long-term oxygen use in patients with COPD (moderate-quality evidence) or ILD (low-quality evidence) with severe chronic resting hypoxemia, 2) a conditional recommendation against long-term oxygen use in patients with COPD with moderate chronic resting hypoxemia, 3) conditional recommendations for ambulatory oxygen use in patients with COPD (moderate-quality evidence) or ILD (low-quality evidence) with severe exertional hypoxemia, 4) a conditional recommendation for ambulatory liquid-oxygen use in patients who are mobile outside the home and require >3 L/min of continuous-flow oxygen during exertion (very-low-quality evidence), and 5) a recommendation that patients and their caregivers receive education on oxygen equipment and safety (best-practice statement).Conclusions: These guidelines provide the basis for evidence-based use of home oxygen therapy in adults with COPD or ILD but also highlight the need for additional research to guide clinical practice.
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13
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Lacasse Y, Tan AYM, Maltais F, Krishnan JA. Home Oxygen in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2019; 197:1254-1264. [PMID: 29547003 DOI: 10.1164/rccm.201802-0382ci] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Two landmark trials conducted more than 35 years ago provided scientific evidence that, under very specific circumstances, long-term oxygen therapy (LTOT) may prolong life. These two trials enrolled 290 patients with chronic obstructive pulmonary disease and severe daytime hypoxemia documented by direct arterial blood gas measurement. From that time, LTOT became a standard of care, and the indications for oxygen therapy expanded to include nocturnal oxygen therapy for isolated nocturnal oxygen desaturation, ambulatory oxygen to correct exercise-induced desaturation, and short-burst oxygen to relieve dyspnea. In most cases, the rationale for broadening the indications for oxygen therapy is that, if hypoxemia exists, correcting it by increasing the FiO2 should help. However, with the exception of LTOT in severely hypoxemic patients with chronic obstructive pulmonary disease, randomized controlled trials of oxygen therapy have failed to demonstrate clinically significant benefits. Also, adherence to LTOT is usually suboptimal. Important areas for future research include improving understanding of the mechanisms of action of supplemental oxygen, the clinical and biochemical predictors of responsiveness to LTOT, the methods for measuring and enhancing adherence to LTOT, and the cost-effectiveness of oxygen therapy. A standardization of terminology to describe the use of supplemental oxygen at home is provided.
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Affiliation(s)
- Yves Lacasse
- 1 Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada; and
| | - Ai-Yui M Tan
- 2 Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - François Maltais
- 1 Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada; and
| | - Jerry A Krishnan
- 2 Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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14
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Lacasse Y, Krishnan JA, Maltais F, Ekström M. Patient registries for home oxygen research and evaluation. Int J Chron Obstruct Pulmon Dis 2019; 14:1299-1304. [PMID: 31417247 PMCID: PMC6592017 DOI: 10.2147/copd.s204391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/17/2019] [Indexed: 01/15/2023] Open
Abstract
Randomized clinical trials are the preferred study design to address key research questions about the benefits or harms of interventions. However, randomized trials of oxygen therapy are difficult to conduct and have limitations. The purpose of this article is to offer our view on the potential use of patient registries in the field of home oxygen in COPD as an alternative to randomized trials by referring to the Swedish experience with a national registry for respiratory failure. Patient registries use observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure. As opposed to administrative databases, patient registries serve one or more predetermined scientific, clinical, or policy purposes. By systematically and prospectively compiling relevant data, patient registries may describe the natural history of a disease, determine effectiveness and cost-effectiveness, assess safety or harm, and measure quality of care. Registry-based randomized trials (ie, randomized trials within a clinical registry) combine the advantages of a prospective randomized trial with the strengths of a large-scale all-comers clinical registry. Challenges and issues in the design and implementation of patient registries include the representativeness of participants, data collection, quality assurance, ownership, and governance. Notwithstanding their limitations, patient registries represent valuable tools in the conduct of research in the area of home oxygen therapy.
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Affiliation(s)
- Yves Lacasse
- Research Center, Quebec University Institute of Cardiology and Pulmonology, Laval University, Québec, QC, Canada
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - François Maltais
- Research Center, Quebec University Institute of Cardiology and Pulmonology, Laval University, Québec, QC, Canada
| | - Magnus Ekström
- Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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15
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Chen JZ, Katz IM, Pichelin M, Zhu K, Caillibotte G, Finlay WH, Martin AR. In Vitro-In Silico Comparison of Pulsed Oxygen Delivery From Portable Oxygen Concentrators Versus Continuous Flow Oxygen Delivery. Respir Care 2019; 64:117-129. [PMID: 30696754 DOI: 10.4187/respcare.06359] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Portable oxygen concentrators (POCs) deliver oxygen in intermittent pulses. The challenge of establishing equivalence between continuous flow oxygen and nominal pulse flow settings on different POCs is well known. In vitro bench measurements and in silico mathematical modeling were used to compare the performance of 4 POCs versus continuous flow oxygen by predicting the FIO2 at the trachea and entering the acini. METHODS Each of the 4 POCs was connected to a 3-dimensional printed replica of a human adult nasal airway via nasal cannula. A test lung simulated 3 breathing patterns representative of a patient with COPD at rest, during exercise, and while asleep. POCs were tested for each breathing pattern at all integer pulse flow settings. Volume-averaged FIO2 was calculated by analyzing oxygen concentrations and inhalation flow over time. In vitro oxygen waveforms were then combined with a single-path mathematical model of the lungs to assess oxygen transport through the conducting airways. In vitro experiments and mathematical modeling were repeated for continuous flow oxygen. RESULTS Continuous flow oxygen consistently delivered more (>2% absolute) oxygen in terms of volume-averaged FIO2 for all nominally equivalent pulse flow settings of >2. Differences were also observed when comparing performances between different POCs, particularly at high device settings (5 and 6). Simulations showed that efficiency of delivery to the acinar region of the lungs was higher in pulse flow than in continuous flow oxygen but that continuous flow oxygen generally delivered a higher absolute volume of oxygen. Differences in absolute oxygen delivery per breath between continuous flow oxygen and pulse flow were smaller for acinar delivery than for tracheal delivery. CONCLUSIONS Significant differences in POC performance based on volume-averaged FIO2 were found between pulse flow and continuous flow oxygen, and among pulse flow modes in different POCs. Although pulse flow was a more efficient mode of delivery than continuous flow oxygen, continuous flow oxygen delivered a greater absolute volume of oxygen per breath.
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Affiliation(s)
- John Z Chen
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada.
| | - Ira M Katz
- Medical R&D, Air Liquide Santé International, Centre de Recherche Paris-Saclay, Les Loges-en-Josas, France
| | - Marine Pichelin
- Medical R&D, Air Liquide Santé International, Centre de Recherche Paris-Saclay, Les Loges-en-Josas, France
| | - Kaixian Zhu
- Centre Explor!, Air Liquide Healthcare, Gentilly, France
| | - Georges Caillibotte
- Medical R&D, Air Liquide Santé International, Centre de Recherche Paris-Saclay, Les Loges-en-Josas, France
| | - Warren H Finlay
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew R Martin
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
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16
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Assayag D, Camp PG, Fisher J, Johannson KA, Kolb M, Lohmann T, Manganas H, Morisset J, Ryerson CJ, Shapera S, Simon J, Singer LG, Fell CD. Comprehensive management of fibrotic interstitial lung diseases: A Canadian Thoracic Society position statement. CANADIAN JOURNAL OF RESPIRATORY CRITICAL CARE AND SLEEP MEDICINE 2018. [DOI: 10.1080/24745332.2018.1503456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Deborah Assayag
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Pat G. Camp
- Department of Physical Therapy & the Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jolene Fisher
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Martin Kolb
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Tara Lohmann
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Helene Manganas
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Julie Morisset
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Christopher J. Ryerson
- Department of Medicine, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Shane Shapera
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jessica Simon
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Lianne G. Singer
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Charlene D. Fell
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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17
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Oxygen Therapy for Interstitial Lung Disease: Physicians’ Perceptions and Experiences. Ann Am Thorac Soc 2017; 14:1772-1778. [DOI: 10.1513/annalsats.201705-372oc] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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