Long-Term Oxygen Therapy in Ioannina

University Hospital of Ioannina, Yannina, Epirus, Greece
Respiration (Impact Factor: 2.59). 12/2004; 71(6):619-24. DOI: 10.1159/000081763
Source: PubMed


Long-term oxygen treatment (LTOT) is very important, especially in patients with severe chronic obstructive pulmonary disease (COPD), but its efficacy is closely related to patient compliance.
The aim of the present study was to investigate the compliance of patients under LTOT in the Prefecture of Ioannina (north-western Greece) and to identify factors that might be involved.
The study included 249 patients treated with LTOT during a 1-year period. They were visited at home by the investigating staff (a chest specialist and a primary care nurse). Compliance to therapy was defined by the daily use of the O2 concentrator (in hours). Patients underwent pulse oximetry, basic spirometry, and trial inhalation of bronchodilators.
Only 67 patients (26.9%) complied with therapy, while the daily concentrator use lasted 9.7 +/- 6.09 h. SaO2, FEV1 and FVC were negatively correlated to patient compliance. No significant differences concerning LTOT compliance were noted between men and women, urban and rural population, and between smokers, ex-smokers and non-smokers. A chest physician recommended LTOT for the majority of patients (86.3%), while COPD was the main reason for LTOT prescription (74.7%). Nevertheless, compliance to LTOT was not significantly higher when prescribed by a respiratory physician. No specific medical instructions and information was recorded for the majority of the study patients treated with LTOT.
Our results suggest that an organized home care program establishing the relative guidelines is necessary for substantial improvement in patient compliance to LTOT in Greece.

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    • "The minimum recommended duration of LTOT is 15 h/day thus representing an adequate oxygen adherence, as it has been established and defined by international guidelines on domiciliary LTOT. Several studies have evaluated compliance to LTOT showing rates ranging from 45 to 70% [20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30] [31] [32]. These clinical trials have determined the extent of patients' oxygen use as well as identified problems. "
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    ABSTRACT: Long-term oxygen therapy (LTOT) is the cornerstone mode of treatment in patients with severe chronic obstructive pulmonary disease (COPD) associated with resting hypoxaemia. When appropriately prescribed and correctly used, LTOT has clearly been shown to improve survival in hypoxemic COPD patients. Adherence to LTOT ranges from 45% to 70% and utilization for more than 15 hours per day is widely accepted as efficacious. Although several studies have addressed the level of patients' adherence to LTOT, few have suggested or evaluated interventions that conduce to compliance enhancement. The lack of sufficient data regarding COPD patients following oxygen prescription is an enormous void that must be duly confronted to augment clinical effectiveness and cost containment for the long term use. The present review article highlights factors influencing the compliance of patients using LTOT and emphasizes novel strategies and interventions that may prove to be of significant benefit given the remarkably little current research appraising this issue. Therefore, additional research should be promptly performed to verify the efficacy of newly designed approaches in improving the outcomes of patients receiving LTOT.
    Full-text · Article · Sep 2011 · Pulmonary Medicine
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    ABSTRACT: Introduction: Long-term oxygen therapy (LTOT) is the only treatment improving survival of patients with respiratory failure due to chronic obstructive pulmonary disease (COPD). Benefits of treatment depend mainly on daily duration of oxygen use. The aim of the study was to assess daily use of oxygen and to evaluate influencing factors. Material and methods: Consecutive patients qualified to LTOT were included. Eligibility for LTOT was based on the ATS/ /ERS guidelines. All patients were instructed to use oxygen from oxygen concentrator for 15 hours per day or more. Duration of oxygen therapy was verified every 4 weeks by visiting respiratory nurse using counter clock of oxygen concentrator. The nurses were also encouraging patients to breath oxygen for at least 15 h/d. Results: Study group consisted of 30 patients (77% with COPD) aged 67 ± 9 yrs, mean FEV1 46 ± 18 % pred., RV%TLC 64 ± 16%, PaO2 50 ± 6 mm Hg. Mean duration of oxygen therapy for the group was 12.5 ± 4.6 h/d. Eleven (37%) subjects followed prescription during whole follow-up period (mean oxygen use 17.4 ± 2.6 h/d). Mean oxygen use in the non-compliant group was 9.6 ± 2.7 h/d. In COPD group compliant patients had significantly lower TLC (100 ± 19% pred. v. 152 ± 36% pred., p = 0.001) and lower PaCO2 (38 ± 6 mm Hg v. 47 ± 8 mm Hg, p < 0.05) when compared to the non-compliant group. During the first month of treatment 48% of patients were compliant. From the second month onward percentage of compliant patients fell to 30% and remained stable to the end of study. Fourteen patients (47%) complained of electricity consumption and 7 patients (23%) complained of the noise of working concentrator. Daily oxygen use in the latest group was significantly lower when compared to those who did not complain of the noise (9 ± 3.7 h/d v. 13.5 ± 4.4 h/d; p = 0.02). Conclusions: The best compliance to home oxygen therapy is observed at the beginning of treatment. Frequent home nurse visits do not improve compliance. We hypothesize that the use of other oxygen sources eg. liquid oxygen, that are silent and do not increase the cost of electricity, could improve compliance.
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    ABSTRACT: Long-term oxygen therapy (LTOT) is the cornerstone mode of treatment in patients with chronic obstructive pulmonary disease (COPD). The present study aims to investigate the effect of two oxygen sources (concentrator and liquid oxygen) on quality of life, exercise tolerance and compliance to LTOT in patients with COPD. The survey included 104 patients with COPD (31 on concentrator treatment and 73 on liquid oxygen). Patients were subjected to pulse oximetry, basic spirometry, measurement of health-related quality of life by the St. George's Hospital respiratory questionnaire instrument and assessment of dyspnoea severity by the modified Borg category scale. Exercise tolerance was evaluated by the S(a)O(2) value after 3 min of walking. S(a)O(2) was measured before and after treatment with each device. Compliance with therapy was defined by the daily duration of oxygen use. The two LTOT groups did not differ significantly concerning pulmonary function tests (p = 0.49 for FEV(1), 0.98 for FVC, 0.15 for FEV(1)/FVC% and 0.38 for FEF(50%)), S(a)O(2) before (p = 0.28) and after (p = 0.80) O(2) treatment and after the 3-min walking trial (p = 0.47), and St. George's Hospital respiratory questionnaire score (p = 0.45). The liquid oxygen group was less dyspnoeic before treatment (p = 0.02), but this difference disappeared after treatment (p = 0.95). A highly significant difference (p < 0.001) was noted concerning the daily oxygen use. Complete compliance to LTOT (> or =15 h/day) was observed in 12.9 and 42.5%, respectively (p < 0.005). Noise disturbance was noted only in the concentrator group (80%). We conclude that stationary liquid oxygen seems to be a satisfactory alternative mode for LTOT treatment in COPD patients, with higher patient compliance to therapy in comparison with concentrators.
    No preview · Article · Feb 2006 · Respiration
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