Chest
Volume 107, Issue 2, February 1995, Pages 358-361
Journal home page for Chest

Clinical Investigations: Oxyzen
Home Oxygen Therapy: A Comparison of 2- vs 6-Month Patient Reevaluation

https://doi.org/10.1378/chest.107.2.358Get rights and content

Study objective

To contrast the effectiveness of 2- vs 6-month reevaluation intervals on both clinical outcome and cost in patients requiring continuous home oxygen therapy (HOT).

Design

Prospective, randomized clinical trial.

Setting

The outpatient program of a university-affiliated Veterans Affairs Medical Center (VAMC) Pulmonary Service.

Patients

Fifty patients were chosen from among a cohort of 200 patients currently enrolled in our HOT program. All met specific arterial blood gas criteria, were able to give informed consent, had at least 6 months of prior HOT usage, and did not have any illness expected to independently shorten life expectancy.

Interventions

Baseline resting oxygen flow rates were prescribed based on the results of arterial blood gas measurements so as to attain a PaO2 > 60 mm Hg. Flow rates were adjusted as needed during a 12-min walk to maintain pulse oximetry readings > 90%. No adjustments in baseline flow rates were made during sleep. Identical evaluations were repeated at either 2- or 6-month intervals.

Measurements and results

At 1-year follow-up, there were no significant differences between the 2- and 6-month groups in any of the clinical outcome parameters measured, ie, number of emergency department visits, number of hospitalizations, number of days hospitalized, or mortality. Total costs were not significantly different between the two groups. Evaluation costs were less in the 6-month follow-up group.

Conclusions

After attaining stability following at least 6 months of continuous HOT usage, patients receiving continuous HOT need not be routinely reevaluated more frequently than every 6 months.

Section snippets

Patient Selection

All patients seen at the Veterans Affairs Medical Center-Pittsburgh (VAMC) have a physician responsible for their care and are followed up in an assigned clinic. Although any physician may refer a patient for home oxygen evaluation, this facility has limited the authority to prescribe home oxygen to the Pulmonary Service. The evaluation is performed in a standardized fashion by a pulmonary nurse specialist. If the patient meets the NOTT arterial blood gas criteria (Table 1), HOT is prescribed.

RESULTS

Except for a paucity of female patients, our population would seem to be quite comparable to the NOTT group (Table 2). In our study, the “all cause” 1-year mortality was 16%. Although 21 (42%) of our subjects had no hospitalizations in the study period, 9 (18%) had three or more hospitalizations (the vast majority of which were related to respiratory problems). The mean number of hospital days per year for those patients requiring hospital admission was 17. The study population had a

DISCUSSION

The only statistically significant clinical outcome difference that we discovered between the 2- and 6-month groups involved the SIP where there was a significant improvement in the 2-month group, but not in the 6-month group when baseline values were compared with those at 1-year follow-up. This improvement was solely attributable to an improvement in the psychosocial subscore. The importance of this finding is unclear. It may be attributed to chance or it may reflect true psychologic benefit

REFERENCES (18)

  • Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease

    Ann Intern Med

    (1980)
  • Durable Medical Equipment Regional Carrier Suppliers’ Manual. August 1993; 13–87,...
  • OpenbrierDR et al.

    Validity and reliability of visual analogue scales (VAS) used to measure symptoms in patients with COPD [abstract]

    Am Rev Respir Dis

    (1989)
  • MuzaSR et al.

    Comparison of scales used to quantitate the sense of effort to breathe in patients with chronic obstructive pulmonary disease

    Am Rev Respir Dis

    (1990)
  • PollardWE et al.

    Sickness impact profile: reliability of a health status measure

    Med Care

    (1976)
  • BergnerM et al.

    Sickness impact profile: validation of a health status measure

    Med Care

    (1976)
  • McGavinCR et al.

    Twelve-minute walking test for assessing disability in chronic bronchitis

    BMJ

    (1976)
  • McSweeny, GrantI et al.

    Life quality of patients with chronic obstructive pulmonary disease

    Arch Intern Med

    (1982)
  • TraverGA

    Measures of symptoms and life quality to predict emergent use of institutional health care resources in chronic obstructive airways disease

    Heart Lung

    (1988)
There are more references available in the full text version of this article.

Cited by (0)

This work was funded by VA grant HSR&D 87–033, NHLBI grant T32 HL07563, and the American Lung Association of Western Pennsylvania.

Reprint requests: Dr. Cottrell, Department of Veterans Affairs Medical Center, University Drive C, Pittsburgh, PA 15240

View full text