Evaluating the Efficiency of Long Term Oxygen Therapy and Mortality in Chronic Obstructive Pulmonary Disease

Abstract

It has been shown that Long Term Oxygen Therapy (LTOT) improves polycythemia secondary to hypoxemia and right heart failure, decreases pulmonary hypertension, improves quality of life and increases life expectancy in COPD patients. In our study we aimed to evaluate clinical data, mortality, patient's adherence and efficiency of the therapy in COPD patients receiving LTOT. Mean age was 70.5%±9.7 and 57% of the participiants were male. It was shown that one year hospital admission count after LTOT (0.56±0.79) was decreased according to one year hospital admission count before LTOT (1.14±1.64). When arterial blood gas values after LTOT compared to the values at the time prescription PaO2 was increased (47.9±4, 53.4±9) and PaCO2 was decreased (56.1±11, 50.5±11). Although there was no significant difference in pulmonary artery pressure after LTOT, a significant increase was determined in hematocrit (38.37±6, 40.14±6). 41.1% of the patients had at least once device maintanence, and after LTOT only 38.4% had a clinical control due to COPD. The most common reason for irregular use was lack of necessity. Mean daily oxygen usage was 13.88±4.35 hours/day and 68.8% of the patients were using 15 hours or more. Mean follow-up of the patients were 17.85±14.53 (1-55) months and mortality rate in this period was 67%. Mortality was higher in LTOT with 15hours/day or more compared to less than 15 hours (respectively 54.6%, 12.5%). In conclusion, all patients with an indication for LTOT should be followed by national registry system and monitored in terms of technical services. Patients adherence and routine controls should be provided.

Keywords

• COPD, mortality, concentrator, oxygen, LTOT

Evaluating the Efficiency of Long Term Oxygen Therapy and Mortality in Chronic Obstructive Pulmonary Disease

Abstract

Kronik Obstrüktif Akciğer Hastalığı (KOAH) olan hastalarda uzun süreli oksijen tedavisi (USOT) hipoksemiye sekonder polisitemiyi ve sağ kalp yetmezliğini düzelttiği, pulmoner hipertansiyonu düşürdüğü, yaşam kalitesini ve yaşam süresini uzattığı gösterilmiştir. Çalışmamızda oksijen konsantratörü ile USOT alan KOAH’lı hastaların klinik verilerini ve mortaliteyi değerlendirmeyi ve bu hastalarda tedavi uyumunu ve USOT’un KOAH’lı hastalar üzerindeki tedavi yararlılığını değerlendirmeyi amaçladık. Çalışmaya alınan hastaların yaş ortalaması %70.5±9.7 olup %57’si erkek idi. USOT sonrası bir yıllık hastane yatış sayısının (0.56±0.79), USOT öncesi bir yıllık hastane yatış sayısına (1.14±1.64) göre azaldığı bulundu. USOT sonrası kan gazlarının, oksijen konsantratörü verildiği dönemdeki kan gazlarıyla kıyaslandığında PaO2’nin (47.9±4, 53.4±9) arttığı, PaCO2’nin (56.1±11, 50.5±11) azaldığı tespit edildi. USOT sonrası pulmoner arter basıncı ve hemoglobinde belirgin bir değişiklik olmazken hematokrit’de (38.37±6, 40.14±6) artış tespit edildi. Çalışmaya katılan hastaların %41.1’i oksijen konsantratörüne en az bir kere bakım yaptırdığı ve USOT sonrası hastaların sadece %38.4’ü (n:43) KOAH nedeniyle en az bir kere poliklinik kontrolüne geldiği tespit edildi. En sık düzensiz USOT kullanma nedeni ise ihtiyaç duymama idi. Çalışmaya alınan hastaların günlük USOT kullanım süresi 13.88±4.35 saat/gün olup, hastaların %68.8’i oksijeni günlük ortalama 15 saat ve üzeri kullanıyordu. Çalışmaya alınan hastaların takip süresi 17.85±14.53 ay olup takip süresi içinde mortalite oranı %67 idi. USOT’ni 15 saat/gün ve üzeri kullanan hastaların mortalitesi kullanmayanlara göre daha yüksekti (%54.6, %12.5). Sonuç olarak USOT endikasyonu olan tüm olgular ulusal kayıt sistemi ile takip edilmeli ve teknik hizmetler yönünden de izlenmelidir. USOT verilen hastaların tedaviye uyumu incelenmeli ve hastaların düzenli kontrole gelmeleri sağlanmalıdır

Keywords

• KOAH, mortalite, konsantratör, oksijen, USOT

References

1. Rabe KF, Hurd S, Anzueto A, et al. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic ob- structive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007;176:532-55.
2. Turkish Thoracic Society. Chronic Obstructive Lung Disease diagnosis and treatment consensus report.Turk Thorac J 2010;11:1-65.
3. Atiş S, Tutluoğlu B, Buğdayci R. Characteristics and com- pliance of patients receiving long-term oxygen therapy (LTOT) in Turkey. Monaldi Arch Chest Dis 2001;56:105-9
4. Zielinski J, Tobiasz M, Hawrylkiewicz I, Sliwinski P, Palasiewicz G. Effects of long-term oxygen therapy on pulmonary hemodynamics in COPD patients: a 6-year pro- spective study. Chest 1998;113:65-70.
5. Weitzenblum E, Sautegeau A, Ehrhart M, Mammosser M, Pelletier A. Long-term oxygen therapy can reverse the progression of pulmonary disease. Am Rev Respir Dis 1985;131:493-8.
6. Levine BE, Bigelow DB, Hamstra RD et al. The role of long-term continuous oxygen administration in patients with chronic airway obstruction with hypoxemia. Ann Intern Med 1967;66:639-50
7. Skwarski K, Macnee W, Wraith PK, Sliwinski P, Zielinski J. Predictors of Survival in Patients COPD. Chest 1991;100:1522-7.
8. Nocturnal Oxygen therapy Trial Group. Continous or noc- turnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Ann Intern Med 1980;93;391-8.

9. Report of the Medical Research Council Working Party. Long-term domiciliary oxygen therapy in chronic bronchi- tis and emphysema. Lancet 1981;1:681-6.
10. European Society of Pneumology Task Group. Recommendations for long term oxygen therapy (LTOT). Eur Respir J 1989;2:160-4.
11. Weitzenblum E. Observance of long-term oxygen therapy at home. Chest 1996;109:1135-6.
12. Restrick LJ, Paul EA, Braid GM, Cullinan P, Moore-Gillon J, Wedzicha JA. Assesment and follow up of patients prescribed long term oxygen treatment. Thorax 1993;48:708-13.
13. Walshaw MJ, Lim R, Evans CC, Hind CR. Factors influ- encing the compliance of patients using oxygen concen- trators for long-term home oxygen therapy. Respir Med 1990;84:331-3.
14. Evans TW, Waterhouse J, Howard P. Clinical experience with the oxygen concentrator. Br Med J (Clin Res Ed) 1983;287:459-61
15. Howard P, Waterhouse JC, Billings CG. Compliance with longterm oxygen therapy by concentrator. Eur Respir J 1992,5:128-9
16. Pepin JL, Barjhoux CE, Deschaux C, Brambilla C. A Long- term oxygen therapy at home. Compliance with medi- cal prescription and effective use of therapy. ANTADIR Working Group on Oxygen Therapy. Association Nationale de Traitement à Domicile des Insuffisants Respiratories. Chest 1996;109:1144-50
17. Akcay Ş, Oner Eyuboğlu F, Celik N. Compliance with Long-Term Oxygen Therapy in Patients with Chronic Respiratory Failure and Related Factors. Tuberk Toraks 2001;49:13-20.
18. Kurtar PN, Uçan ES, Şahbaz S, et al. Efficiency of Long Term Oxygen Therapy and Patients Therapy Compliance. Thorax J (Turkish) 2007;8:163-9.
19. Viskum K. Organization of professional care services with special reference to LTOT. Monaldi Arch Chest Dis 1993;48:453-7
20. Block AJ, Burrows B, Kanner RE et al. Oxygen administra- tion in the home. Am Rev Respir Dis 1977;115:897-9
21. Cooper CB, Howard P. An analysis of sequential physi- ologic changes in hypoxic cor pulmonale during long-term oxygen therapy. Chest 1991;100:76-80.
22. Taskar VS, Rupware RU, Kulkarni H, Kamat SR. Effect of 3 week oxygen therapy on functional and haemodynamic parameters in chorinic obstructive pulmonary disease. J Assoc Physicins India 1990;38:839-42.
23. Düzenli H, Doğan OT, Berk S, Ozşahin SL, Akkurt I. The effects of long-term oxygen therapy on survey in pa- tients with chronic respiratory failure. Tuberk Toraks 2008;56:179-86.
24. Tutluoğlu B, Atış S, Özge C, Salepçi B, Yılmazkaya Y. Long- Term Oxygen therapy in chronic obsructive pulmonary diseases. Respir Dis (Turkish) 2000;11:338-42.
25. Yentürk EP, Umut S. Long-term oxygen therapy in chron- ic obstructive pulmonary disease patients; efficacy and compliance to treatment. Solunum 2002;4:391-5.
26. Kanner RE, Renzetti AD Jr, Stanish WM, Barkman HW Jr, Klauber MR. Predictors of survival in subjects with chron- ic airflow limitation. Am J Med 1983;74:249-55.
27. Anthonisen NR, Wright EC, Hodgkin JE.Prognosis in chronic obstructive pulmonary disease. Am Rev Respir Dis 1986;133;14-20.
28. Veale D, Chailleux E, Taytard A, Cardinaud JP. Characteristics and survival of patients prescribed long- term oxygen therapy outside prescription guidelines. Eur Respir J 1998;12:780-4.
29. Górecka D, Gorzelak K, Sliwiński P, Tobiasz M, Zieliński J. Effect of long-term oxygen therapy on survival in patients with chronic obstructive pulmonary disease with moder- ate hypoxaemia. Thorax 1997;52:674-9.