ABSTRACT
Home oxygen therapy is an acknowledged treatment for patients suffering from chronic hypoxaemia, due to pulmonary or cardiac disease, and may have positive effects on survival and quality of life. The risks and side effects of the treatment are usually mild, and the equipment has developed to become relatively affordable, accessible and easy to transport. Adjustments in the oxygen settings can be necessary when travelling by airplane or during physical effort or sleep. Prescription and follow-ups are usually best maintained by hospital departments with expertise in pulmonary medicine, as argued in this review.
Subject(s)
Oxygen Inhalation Therapy , Quality of Life , Humans , Oxygen Inhalation Therapy/adverse effects , Lung , Oxygen , Denmark , Hypoxia/etiology , Hypoxia/therapyABSTRACT
Objective: Devices for Automated Oxygen Administration (AOA) have been developed to optimize the therapeutic benefit of oxygen supplementation. We aimed to investigate the effect of AOA on multidimensional aspects of dyspnea and as-needed consumption of opioids and benzodiazepines, as opposed to conventional oxygen therapy, in hospitalized patients with Acute Exacerbation of COPD (AECOPD). Method and Patients: A multicenter randomized controlled trial across five respiratory wards in the Capital Region of Denmark. Patients admitted with AECOPD (n=157) were allocated 1:1 to either AOA (O2matic Ltd), a closed loop device automatically delivering oxygen according to the patient's peripheral oxygen saturation (SpO2), or conventional nurse-administered oxygen therapy. Oxygen flows and SpO2 levels were measured by the O2matic device in both groups, while dyspnea, anxiety, depression, and COPD symptoms were accessed by Patient Reported Outcomes. Results: Of the 157 randomized patients, 127 had complete data for the intervention. The AOA reduced patients' perception of overall unpleasantness significantly on the Multidimensional Dyspnea Profile (MDP) with a difference in medians of -3 (p=0.003) between the intervention group (n=64) and the control group (n=63). The AOA also provided a significant between group difference in all single items within the sensory domain of the MDP (all p-values≤0.05) as well as in the Visual Analogue Scale - Dyspnea (VAS-D) within the past three days (p=0.013). All between group differences exceeded the Minimal Clinical Important Difference of the MDP and VAS-D, respectively. AOA did not seem to have an impact on the emotional response domain of the MDP, the COPD Assessment Test, the Hospital Anxiety and Depression Scale, or use of as-needed opioids and/or benzodiazepines (all p-values>0.05). Conclusion: AOA reduces both breathing discomfort and physical perception of dyspnea in patients admitted with AECOPD but did not seem to impact the emotional status or other COPD symptoms.
Subject(s)
Pulmonary Disease, Chronic Obstructive , Humans , Pulmonary Disease, Chronic Obstructive/diagnosis , Oxygen Inhalation Therapy , Dyspnea/therapy , Hospitalization , OxygenABSTRACT
Recently, health technology systems offering monitoring of the peripheral oxygen saturation level and automated oxygen administration (AOA) have emerged. AOA has been shown to reduce duration of hypoxemia and the length of hospital stay, but the patients' perspective on AOA has not been investigated. This qualitative study, based on the interpretive description methodology, aimed to explore how patients hospitalized with exacerbation of chronic obstructive pulmonary disease (COPD) experience being treated with AOA. Eighteen patients treated with AOA were included in the study. Data was collected during admission or in the patients' homes using semi-structured interviews focusing on patients' experiences of AOA using the word "robot" as used by patients. The findings revealed two themes "adaptation of behavior to the robot" and "robots can make patients feel safe but not cared for" and six subthemes. Our findings illustrate how patients were willing to compromise their own therapy and thereby safety by avoiding behavior triggering AOA alarms and disturbing their fellow patients and the health care professionals. Adherence, defined as patients' consistency in taking their medications as prescribed, becomes an important point of attention for health professionals when applying individualized robotic therapies such as AOA to patients with COPD. To support patients in the process of managing adherence to therapeutic technology, we propose a person-centered care approach that, through education and communication with the patients, generates an understanding of how they can self-manage AOA and its alarms without activating avoiding behavior that threatens their treatment and recovery.
Subject(s)
Pulmonary Disease, Chronic Obstructive , Humans , Pulmonary Disease, Chronic Obstructive/therapy , Qualitative Research , Oxygen Inhalation Therapy , Hospitalization , OxygenABSTRACT
Chronic obstructive pulmonary disease (COPD) is a leading cause of hospitalisation in Danish adults, and admission rates are expected to increase in the future. Assisted home care with disease monitoring and treatment by a pulmonary nurse may reduce time spent at hospital and the economic burden of COPD. In order to evaluate various types of assisted home care, the selection of patients, feasibility, effect, safety, and cost-effectiveness, the literature was reviewed. Most information is available on assisted home care following a hospital-based assessment and led by a respiratory nurse. According to the literature, assisted home care is a well tolerated, safe, and economic alternative to hospital admission for about 25-30% of the patients referred to hospital due to exacerbation of COPD. We recommend that assisted home care is tested in Denmark.
