Robert W McCoy

Options for Home Oxygen Therapy Equipment: Storage and Metering of Oxygen in the Home

Home oxygen therapy equipment options have increased over the past several decades, in response to innovations in technology, economic pressure from third-party payers, and patient demands. The delivery of oxygen in the home has evolved from packaged gas systems containing 99% United States Pharmacopeia oxygen provided by continuous-flow delivery to intermittent-flow delivery, with oxygen concentrators delivering < 99% oxygen purity. The majority of published papers indicating the value of long-term oxygen therapy have been based on continuous-flow delivery of 99% United States Pharmacopeia oxygen. The lack of research on new home oxygen therapy devices requires more clinical involvement from physician and respiratory therapist to evaluate the performance of oxygen devices used in the home to ensure the patient is provided adequate oxygenation at all activity levels. New standards of care are required to address the need to have consistent titration of long-term oxygen therapy to meet the patients home needs at all activity levels. Consistent labeling of metering devices on home oxygen equipment will need to be developed by professional medical societies to be implemented by standards organizations that direct industrial manufacturers. Home oxygen therapy will need professionally trained respiratory therapists reimbursed for skills and service to ensure that patients receive optimal benefits from home oxygen equipment to improve patient outcomes and prevent complications and associated costs.

Patient-Centric LTOT: No Room for Complacency

The benefits of the continuous administration of supplemental long-term oxygen therapy (LTOT) for the amelioration of the sequelae of severe chronic hypoxemia (baseline PaO2 ≤ 55 mg Hg or SpO2 ≤ 88%) secondary to COPD, are well established. When properly prescribed and delivered, LTOT improves

Effects of a Highly Portable Noninvasive Open Ventilation System on Activities of Daily Living in Patients with COPD

Background: For patients with chronic obstructive pulmonary disease (COPD), an increase in exercise tolerance and ability to perform activities of daily living (ADLs) can mean an improved quality of life with fewer exacerbations and lower health care expenses. We evaluated a wearable, noninvasive open ventilation (NIOV) system designed to enhance exercise capacity and increase mobility. Methods: Patients with stable, oxygen-dependent COPD were recruited for this prospective, open-label, crossover study. Inclusion criteria included supplemental oxygen use, elevated dyspnea score, and the ability to perform ADLs. Patients performed a selected ADL for as long as tolerable while using standard oxygen therapy. Following a rest period, the same ADL was repeated using the NIOV system. ADL endurance time, oxyhemoglobin saturation measured by pulse oximeter ( SpO2), dyspnea, fatigue, and discomfort scores were recorded. Results: Thirty patients were enrolled and 29 patients completed the study. Mean ADL endurance increased by 85% (13.4 vs. 7.2 min) using NIOV compared with oxygen therapy (p<0.0001). Mean SpO2 was significantly higher during ADLs using NIOV versus oxygen therapy (p<0.0001). Median dyspnea, fatigue, and discomfort scores were significantly lower using NIOV during ADLs compared to oxygen therapy (p<0.01). No device-related adverse events were observed. Conclusions: This study demonstrated that a novel, portable noninvasive open ventilation system can improve ADL performance in the home setting. Compared to standard oxygen therapy, the NIOV system provided statistically and clinically significant increases in ADL endurance time and oxygenation, while decreasing dyspnea, fatigue, and discomfort. The NIOV system appears to offer a practical option for increasing activity and exercise tolerance in oxygen-dependent patients with COPD.