Patterns of Domestic Activity and Ambulatory Oxygen Usage in COPD

doi:10.1378/chest.07-1848

Chest

Volume 134, Issue 4, October 2008, Pages 753-760

https://doi.org/10.1378/chest.07-1848 Get rights and content

Background

The aim of this study was to examine patterns of domestic activity and ambulatory oxygen usage in patients with COPD in their domestic environment.

Methods

Twenty patients (14 men; mean age, 73.4 years [SD, 6.8 years]; FEV₁, 1.0 L [SD, 0.5 L]) with stable COPD were recruited after completing a 7-week pulmonary rehabilitation program. Patients were either hypoxic at rest or had desaturation during exercise. Patients were randomized to an 8-week, double-blind, placebo-controlled trial of cylinder oxygen vs cylinder air. Total domestic physical activity and health-related quality of life (HRQL) measures were recorded before and after intervention.

Results

There were no significant changes in domestic activity or HRQL measures after the intervention for either cylinder oxygen or cylinder air, except for a worsening of the Chronic Respiratory Questionnaire dyspnea domain on cylinder air. There was a significant increase in mean duration (minutes per day) of cylinder use (p < 0.05) between weeks 1 vs 7 and weeks 1 vs 8 for the oxygen group. However, when comparing the two groups together, there were no between-group differences in cylinder use or time spent outside the home. Over the 8 weeks the majority of patients were using the cylinders in the home rather than outside, however, the number of times patients reported using the cylinders outside the home increased over the 8 weeks for the oxygen group.

Conclusion

In the short term, ambulatory oxygen therapy is not associated with improvements in physical activity, HRQL, or time spent away from home. However, the use of cylinder oxygen increased over the 8 weeks compared to cylinder air. Patients need time to learn how to use oxygen, and ambulatory oxygen appears to enhance activities rather than increase them.

Trial registration

National Research Register N0123109178.

Section snippets

Patient Recruitment

Clinically stable patients with COPD (FEV₁ < 50% of predicted) were entered into a randomized, double-blinded, placebo-controlled trial of cylinder oxygen vs cylinder air. Patients had completed a 7-week pulmonary rehabilitation program prior to the study to maximize physical function.

Inclusion Criteria

Inclusion criteria were patients who were hypoxic at rest, were receiving LTOT, or demonstrated exercise-induced desaturation. The latter was accepted as arterial oxygen desaturation > 4% below 90% on a standard

Patient Characteristics

Fifty-two patients were initially screened, and the study profile is shown in Figure 1. Forty-two patients completed all walk tests. Twelve patients withdrew after the initial walk tests. Thirty patients were randomized to the 8-week home study, during which 9 patients withdrew and 1 patient died. The main reasons why patients withdrew from the study include having an exacerbation and the weight and lack of esthetics of the cylinder. One patient withdrew because he believed there was no

Discussion

The results of this study suggest that ambulatory oxygen therapy does not in the short term increase domestic activity or time spent outside the home. However, the gradual increase in oxygen cylinder usage suggests that there is an unrecognized benefit from ambulatory oxygen that may take some time to become evident. Also, there was no difference in health status between before and after intervention for either group.

Physical activity monitors represent an opportunity to examine domestic

Conclusion

In conclusion, an 8-week, randomized, double-blind controlled study of ambulatory oxygen following a 7-week pulmonary rehabilitation program did not significantly improve total physical activity or HRQL. However there was a gradual increase in the use of cylinder oxygen over the 8 weeks. There are likely to be some benefits to the use of ambulatory oxygen to explain the increased usage. The nature of this benefit of ambulatory oxygen remains unclear; however, they may be subtle and take time to

Acknowledgment

The authors acknowledge Air Products for the supply of cylinders.

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In adults with advanced lung disease, the 1-minute sit-to-stand test underestimates exertional desaturation compared with the 6-minute walk test: an observational study
2023, Journal of Physiotherapy
In adults with advanced lung disease, do the 6-minute walk test (6MWT) and 1-minute sit-to-stand test (1minSTS) elicit similar cardiorespiratory responses? Can the 6-minute walk distance (6MWD) be estimated from the 1minSTS result?
Prospective observational study using data collected during routine clinical practice.
Eighty adults (43 males) with advanced lung disease, a mean age of 64 years (SD 10) and a mean forced expiratory volume in 1 second of 1.65 L (SD 0.77).
Participants completed a 6MWT and a 1minSTS. During both tests, oxygen saturation (SpO₂), pulse rate, dyspnoea and leg fatigue (Borg 0 to 10) were recorded.
Compared with the 6MWT, the 1minSTS resulted in higher nadir SpO₂ (MD 4%, 95% CI 3 to 5), lower end-test pulse rate (MD –4 beats/minute, 95% CI –6 to –1), similar dyspnoea (MD –0.3, 95% CI –0.6 to 0.1) and greater leg fatigue (MD 1.1, 95% CI 0.6 to 1.6). Among the participants who demonstrated severe desaturation (SpO₂ nadir < 85%) on the 6MWT (n = 18), five and ten participants were classified as moderate (nadir 85 to 89%) or mild desaturators (nadir ≥ 90%), respectively, on the 1minSTS. The relationship between the 6MWD and 1minSTS was: 6MWD (m) = 247 + (7 × number of transitions achieved during the 1minSTS) with poor predictive ability (r² = 0.44).
The 1minSTS elicited less desaturation than the 6MWT and classified a smaller proportion of people as ‘severe desaturators’ on exertion. It is therefore inappropriate to use the nadir SpO₂ recorded during a 1minSTS to make decisions about whether strategies are needed to prevent severe transient exertional desaturation during walking-based exercise. Further, the extent to which performance on the 1minSTS can estimate a person’s 6MWD is poor. For these reasons, the 1minSTS is unlikely to be helpful when prescribing walking-based exercise.
Pulmonary Rehabilitation
2015, Murray and Nadel's Textbook of Respiratory Medicine: Volume 1,2, Sixth Edition
Comparison of domiciliary oxygen using liquid oxygen and concentrator in northern Taiwan
2014, Journal of the Formosan Medical Association
Citation Excerpt :
A study conducted with limited data from the French ANTADIR registry advocates the use of liquid oxygen for selected patients who wish to be mobile.8 In the United States, a liquid oxygen system is used to improve patient's mobility.27 We compared our data to those of a 1991–1992 home oxygen therapy study among US Medicare beneficiaries. 23
Long-term oxygen therapy has become standard treatment for patients with chronic respiratory insufficiency. However, patterns of long-term home oxygen therapy have not been well studied in Taiwan. Oxygen concentrator systems are commonly used in Taiwan, but liquid oxygen delivery systems are portable and may provide advantages over the concentrator system. This study compared oxygen usage between patients from a liquid oxygen group (LOG) and an oxygen concentrator group (OCG). The authors also assessed the physiologic responses of patients with chronic obstructive pulmonary disease (COPD) to ambulatory oxygen use at home.
The study used a retrospective, cross-sectional, observational survey design. The LOG comprised 42 patients, and the OCG comprised 102 patients. We recruited participants in northern Taiwan from July 2009 to April 2010. The questionnaire instruments that were used to collect data consisted of three parts: demographic characteristics, devices used in respiratory care, and activity status with portable oxygen. Two-minute walking tests were performed on COPD patients in their homes.
COPD was the most common diagnosis in our study, with more than 50% of patients who received oxygen long term in both groups having received this diagnosis. The LOG used oxygen for an average of 21.7 hours per day, whereas OCG averaged 15.2 hours per day (p < 0.001). In the OCG, 92.2% of patients used a concentrator alone, whereas 23.8% of the LOG used liquid oxygen alone (p < 0.001). The LOG patients were involved in significantly more outdoors activities (p = 0.002) and reported traveling with oxygen more often (p < 0.001) than the OCG patients. For patients with the same dyspnea level of COPD severity, those using liquid oxygen had a lower increase in pulse rate after the walking test, in comparison with the concentrator users.
Patients in the LOG used oxygen for longer hours, went on more outings, and were more likely to travel with oxygen than patients in the OCG. Being ambulatory with liquid oxygen might enable patients with COPD to walk more effectively.
Pulmonary rehabilitation: A review of the recent literature
2012, Chest
Pulmonary rehabilitation (PR) is an evidence-based, multidisciplinary, comprehensive intervention that can be integrated into the management of individuals with chronic lung disease. It aims to reduce symptoms, optimize function, increase participation in daily life, and reduce health-care resource utilization. In this review, we summarize the new developments in PR over the past 5 years. Issues related to patient assessment include a comparison of cycle- and walking-based measures of exercise capacity, the emergence of multidimensional indices, the refinement of the minimal clinically important difference, and the importance of assessing physical activity. Issues related to exercise training focus on strategies to optimize the training load. We also comment on the acquisition of self-management skills, balance training, optimizing access, and maintaining gains following completion of PR.
Patients with chronic obstructive pulmonary disease (COPD) who are not hypoxaemic at rest do not benefit from home oxygen
2011, Journal of Physiotherapy
Efficacy and patterns of ambulatory oxygen usage – experience of a university hospital
2011, Revista Portuguesa de Pneumologia (English Edition)
Citation Excerpt :
Patient perspectives about the use of AO should be taken into account and it is interesting that 4 patients said that they would never leave their home without oxygen, although this point was not included in the questionnaire. Their experience may be attributed to a learned oxygen-related decrease in exertional dyspnea in daily activities, despite dyspnea relief was not sensed in 6MWT.9 As suggested by other studies, a placebo effect cannot be excluded.27
To determine patterns of ambulatory oxygen (AO) use among patients with chronic obstructive pulmonary disease (COPD) and interstitial lung diseases, and analyze the effects of this therapy on daily activities and quality of life (QoL).
We included 37 consecutive adult patients on AO by liquid O₂ for more than three months prescribed by hospital pulmonologists. The acute response to O₂ was evaluated through the standardized 6-minutes walk test (6MWT) and the Borg dyspnea scale during the O₂ pre-intervention trial. Time spent away from home, compliance, side effects and QoL (SF-36 v1 questionnaire) were evaluated by a telephone interview during the follow-up period. Time spent away from home and QoL comparisons after and before the intervention were assessed retrospectively.
COPD was the most frequent diagnosis (54%), and 29 (78%) patients were already on long-term oxygen therapy. In relation to the acute response to O₂ evaluated through the 6MWT, there were significant improvements in the distance walked (p < 0.001), in resting SatO₂ (p < 0.001), in minimal SatO₂ (p < 0.001), and in percentage of desaturation (p = 0.002), independently of the diagnosis. No differences were observed in Borg dyspnea scale. AO was used for a mean of 4.1 h/day. Patients spent fewer hours per day away from home after AO treatment (3.5 h vs. 5.0 h, p < 0.025). Six patients (16%) were not compliant to the prescription, and 54% mentioned side effects. We verified low scores in almost all of the sub-domains of SF-36 QoL questionnaire, with a significant improvement noted only in emotional role (p = 0.032). Improvement in health global state was described by 49% of patients.
Acute improvement in 6MWT parameters was not predictive of enhancement of outdoor activities and QoL with AO. More detailed studies are needed to achieve evidence based AO benefits.
Determinar os padrões de utilização da Oxigenoterapia de Deambulação (OD) em doentes com doença pulmonar obstrutiva crónica (DPOC) e doenças pulmonares intersticiais, e analisar os efeitos dessa terapêutica nas actividades diárias e na qualidade de vida (QV).
Foram incluídos consecutivamente 37 doentes adultos sob OD com oxigénio líquido há mais de 3 meses, prescrita por médicos pneumologistas hospitalares. A resposta aguda ao oxigénio foi avaliada através da prova de marcha de 6 minutos (PM6 M) e do grau de dispneia de Borg, durante o teste com oxigénio pré-intervenção. O tempo passado fora de casa, a adesão à terapêutica, os efeitos adversos e a QV (questionário SF-36 v1) foram avaliados através de uma entrevista telefónica durante o período de seguimento. A análise comparativa do tempo passado fora de casa e da QV antes e depois da intervenção foi efectuada retrospectivamente.
A DPOC foi o diagnóstico mais frequente (54%), e 29 (78%) doentes encontravam-se sob oxigenoterapia de longa duração. Relativamente à resposta aguda ao oxigénio avaliada através da PM6 M, houve melhoria significativa na distância percorrida (p < 0.001), na SatO₂ em repouso (p < 0.001), na SatO₂ mínima (p < 0.001), e na percentagem de dessaturação (p = 0.002), independente do diagnóstico. Não foram observadas diferenças no grau de dispneia de Borg. A média de horas de uso da OD foi de 4.1 h/dia. Os doentes passaram menos horas por dia fora de casa após tratamento com OD (3.5 h vs. 5.0 h, p < 0.025).
Seis doentes (16%) não cumpriram a terapêutica de acordo com a prescrição, e 54% mencionaram efeitos adversos. Relativamente aos subdomínios do questionário de QV, verificaram-se baixas pontuações em quase todos, com uma melhoria significativa observada apenas no desempenho emocional (p = 0.032). Uma melhoria no estado global de saúde foi descrita por 49% dos doentes.
A melhoria aguda constatada nos parâmetros da PM6 M não foi preditiva de promoção de actividades no exterior e de melhoria da QV com a OD. São necessários estudos mais detalhados para se constatarem benefícios da OD baseados na evidência.

View all citing articles on Scopus

This research was performed in the Department of Pulmonary Rehabilitation, Glenfield Hospital, Leicester, UK.

NRR data provider: University Hospital of Leicester NHS Trust.

The authors have no conflicts of interest concerning this research to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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Chest

Original ResearchCOPDPatterns of Domestic Activity and Ambulatory Oxygen Usage in COPD

Background

Methods

Results

Conclusion

Trial registration

Section snippets

Patient Recruitment

Inclusion Criteria

Patient Characteristics

Discussion

Conclusion

Acknowledgment

Respir Med

Chest

Chest

Ambulatory oxygen for chronic obstructive pulmonary disease (Cochrane Review)

The Cochrane Library 2004; issue 2

Clinical component for the home oxygen service in England and Wales: this document has been prepared by members of the British Thoracic Society (BTS) Working Group on Home Oxygen Services, which is a subcommittee of the Standards of Care Committee of the BTS

Assessment and follow-up of patients prescribed long term oxygen treatment

Thorax

Randomised controlled trial of pulmonary rehabilitation in patients with severe chronic obstructive pulmonary disease stratified for disability

Eur Respir J

Activity monitors can detect brisk walking in patients with obstructive pulmonary disease

J Cardiopulm Rehabil

A profile of daily activity in chronic obstructive pulmonary disease

J Cardiopulm Rehabil

Characteristics of physical activity in daily life in chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Short burst oxygen therapy after activities of daily living in the home in COPD

Thorax

Ventilatory muscle function during exercise in air and oxygen in patients with chronic air-flow limitation

Am Rev Respir Dis

Randomised trial of ambulatory oxygen in oxygen-dependent COPD

Eur Respir J

Original Research
COPD
Patterns of Domestic Activity and Ambulatory Oxygen Usage in COPD