Search

Background: Exercise-induced hypoxaemia is a hallmark of chronic fibrotic interstitial lung disease (f-ILD). It remains unclear whether patients' severe hypoxaemia may exaggerate locomotor muscle fatigue and, if so, to what extent oxygen (O2) supplementation can ameliorate these abnormalities.Methods: Fifteen patients (12 males, 9 with idiopathic pulmonary fibrosis) performed a constant-load (60% peak work rate) cycle test to symptom limitation (Tlim) while breathing medical air. Fifteen age-matched and sex-matched controls cycled up to patients' Tlim. Patients repeated the exercise test on supplemental O2 (42%±7%) for the same duration. Near-infrared spectroscopy assessed vastus lateralis oxyhaemoglobin concentration ((HbO2)). Pre-exercise to postexercise variation in twitch force (∆Tw) induced by femoral nerve magnetic stimulation quantified muscle fatigue.Results: Patients showed severe hypoxaemia (lowest O2 saturation by pulse oximetry=80.0%±7.6%) which was associated with a blunted increase in muscle (HbO2) during exercise vs controls (+1.3±0.3 µmol vs +4.4±0.4 µmol, respectively; p<0.001). Despite exercising at work rates ∼ one-third lower than controls (42±13 W vs 66±13 W), ∆Tw was greater in patients (∆Tw/external work performed by the leg muscles=-0.59±0.21 %/kJ vs -0.25±0.19 %/kJ; p<0.001). Reversal of exertional hypoxaemia with supplemental O2 was associated with a significant increase in muscle (HbO2), leading to a reduced decrease in ∆Tw in patients (-0.33±0.19 %/kJ; p<0.001 vs air). Supplemental O2 significantly improved leg discomfort (p=0.005).Conclusion: O2 supplementation during exercise improves leg muscle oxygenation and fatigue in f-ILD. Lessening peripheral muscle fatigue to enhance exercise tolerance is a neglected therapeutic target that deserves clinical attention in this patient population. [ABSTRACT FROM AUTHOR]

Recommendation of oxygen therapy must include clear indication and benefits of its use, appropriate prescription, vigilant monitoring and appropriate methods of delivery. Home oxygen therapy is expensive, inconvenient and cumbersome; it should be recommended only if benefits outweigh the disadvantages and adverse effects of oxygen. GPs play an important supportive and supervisory role in the use of long-term oxygen therapy (LTOT) to improve mortality of patients with chronic hypoxaemia. Prescription of short burst oxygen therapy (SBOT) for palliation of breathlessness is without clear evidence of its efficacy. GPs can prescribe SBOT when other secondary causes of breathlessness are excluded or treated, when breathlessness is not relieved by other treatments and if an improvement can be documented in patients

Summary: Domiciliary oxygen therapy is widely used in patients with chronic obstructive pulmonary disease (COPD) to relieve hypoxaemia, breathlessness, or both. In this article we review the evidence for domiciliary oxygen—namely long-term oxygen therapy (LTOT), ambulatory oxygen and short burst oxygen therapy—in patients with stable COPD and consider how treatment should be used. LTOT prolongs life in patients with chronic hypoxaemia, while breathing oxygen during exercise increases walking distance and reduces dyspnoea. The evidence that short burst oxygen therapy is useful remains weak despite its widespread use. Whatever form of oxygen therapy is used, it should be acceptable to patients and, therefore, patient education is important. All patients should have their treatment optimised, and the physician should be clear about what form of oxygen therapy is indicated and how its effectiveness is to be assessed. [Copyright &y& Elsevier]

Introduction: The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for home oxygen provision in the UK, together with measurable markers of good practice. Quality statements are based on the British Thoracic Society (BTS) Guideline for Home Oxygen Use in Adults., Methods: Development of BTS Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards., Results: 10 quality statements have been developed, each describing a key marker of high-quality, cost-effective care for home oxygen use, and each statement is supported by quality measures that aim to improve the structure, process and outcomes of healthcare., Discussion: BTS Quality Standards for home oxygen use in adults form a key part of the range of supporting materials that the society produces to assist in the dissemination and implementation of a guideline's recommendations., Competing Interests: Competing interests: The British Thoracic Society operates a Declaration of Interest scheme, and it was a requirement that all members of the development group completed a Declaration of Interest form on an annual basis for the duration of the project. Forms were submitted annually by all authors, and all have confirmed that none of their interests were linked to home oxygen and therefore this document.

The 2015 British Thoracic Society (BTS) Home Oxygen Guidelines provides detailed evidence-based guidance for the use of oxygen by patients in their own homes or other non-acute hospital settings., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

We searched MEDLINE, EMBASE and the Cochrane Controlled Trials Register to determine whether oxygen relieves dyspnoea in mildly or non-hypoxemic COPD and included 18 randomised controlled trials (431 participants) in the meta-analysis using Cochrane methodology. Oxygen therapy reduced dyspnoea when compared with medical air; standardised mean difference -0.37 (95% CI -0.50 to -0.24; I(2)=14%). In a priori subgroup and sensitivity analyses, dyspnoea was reduced by continuous oxygen during exertion but not short-burst oxygen therapy. Continuous exertional oxygen can relieve dyspnoea in mildly or non-hypoxemic COPD, but evidence from larger clinical trials is needed., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Recommendation of oxygen therapy must include clear indication and benefits of its use, appropriate prescription, vigilant monitoring and appropriate methods of delivery. Home oxygen therapy is expensive, inconvenient and cumbersome; it should be recommended only if benefits outweigh the disadvantages and adverse effects of oxygen. GPs play an important supportive and supervisory role in the use of long-term oxygen therapy (LTOT) to improve mortality of patients with chronic hypoxaemia. Prescription of short burst oxygen therapy (SBOT) for palliation of breathlessness is without clear evidence of its efficacy. GPs can prescribe SBOT when other secondary causes of breathlessness are excluded or treated, when breathlessness is not relieved by other treatments and if an improvement can be documented in patients.