Search

Resumen: La oxigenoterapia crónica domiciliaria (OCD) consiste en el uso terapéutico del oxígeno a concentraciones mayores de las que se encuentran en el aire ambiente, con la intención de tratar o prevenir las manifestaciones a largo plazo de la hipoxia. Esta terapia ha demostrado aumentar la supervivencia en los enfermos con enfermedad pulmonar obstructiva crónica (EPOC) e insuficiencia respiratoria crónica (IRC). Este concepto se ha extendido por analogía a la IRC originada por otras enfermedades respiratorias y no respiratorias, sin que su efectividad haya podido ser demostrada. La OCD no se ha demostrado efectiva en mejorar la supervivencia de pacientes con EPOC e hipoxemia moderada. Tampoco hay consenso sobre su empleo durante las desaturaciones nocturnas en EPOC y durante las desaturaciones al esfuerzo. La OCD actual debe valorar la situación clínica y social, adecuando las fuentes de administración de oxígeno al perfil de movilidad de los pacientes, conseguir la adecuada selección de paciente y fuente de oxígeno y es imprescindible titular la oxigenoterapia para asegurar la corrección de la hipoxemia. La búsqueda del equipo de oxígeno ideal, mejorar los sistemas de regulación e información de las terapias, avanzar en la educación de los pacientes y potenciar la investigación, son líneas de trabajo que nos marcan el futuro de la OCD. Abstract: Continuous home oxygen therapy (HOT) is the therapeutic use of oxygen at higher concentrations than those found in ambient air for treating or preventing long-term manifestations of hypoxia, and has been shown to increase survival in patients with chronic obstructive pulmonary disease (COPD) and chronic respiratory failure (CRF). This concept has been extended by analogy to CRF originating from other respiratory and non-respiratory diseases, but its effectiveness has not been demonstrated. HOT has not been shown to be effective in improving the survival of patients with COPD and moderate hypoxemia, nor is there any consensus on its use during nocturnal desaturations in COPD and desaturations caused by exertion. In the current use of HOT, the patient's clinical and social situation should be assessed, oxygen supply sources must be adapted to the patient's mobility profile, the appropriate oxygen source must be selected for each patient, and oxygen therapy must be titrated to ensure that hypoxemia is corrected. Lines of research that will shape the future of HOT include investigating the ideal equipment, improving regulation systems and information about treatments, educating patients, and promoting research.

OBJECTIVE: The COPD Assessment Test (CAT) has been proposed for assessing health status in COPD, but little is known about its longitudinal changes. The objective of this study was to evaluate 1-year CAT variability in patients with stable COPD and to relate its variations to changes in other disease markers. METHODS: We evaluated the following variables in smokers with and without COPD at baseline and aft er 1 year: CAT score, age, sex, smoking status, pack-year history, BMI, modified Medical Research Council (mMRC) scale, 6-min walk distance (6MWD), lung function, BODE (BMI, obstruction, dyspnea, exercise capacity) index, hospital admissions, Hospital and Depression Scale, and the Charlson comorbidity index. In patients with COPD, we explored the association of CAT scores and 1-year changes in the studied parameters. R ESULTS: A total of 824 smokers with COPD and 126 without COPD were evaluated at baseline and 441 smokers with COPD and 66 without COPD 1 year later. At 1 year, CAT scores for patients with COPD were similar ( ± 4 points) in 56%, higher in 27%, and lower in 17%. Of note, mMRC scale scores were similar ( ± 1 point) in 46% of patients, worse in 36%, and better in 18% at 1 year. One-year CAT changes were best predicted by changes in mMRC scale scores ( β -coefficient, 0.47; P