Effect of Automated Oxygen Titration during Walking on Dyspnea and Endurance in Chronic Hypoxemic Patients with COPD: A Randomized Crossover Trial

Linette Marie Kofod, Elisabeth Westerdahl, Morten Tange Kristensen, Barbara Cristina Brocki, Thomas Ringbæk, Ejvind Frausing Hansen, Linette Marie Kofod, Elisabeth Westerdahl, Morten Tange Kristensen, Barbara Cristina Brocki, Thomas Ringbæk, Ejvind Frausing Hansen

Abstract

The need for oxygen increases with activity in patients with COPD and on long-term oxygen treatment (LTOT), leading to periods of hypoxemia, which may influence the patient's performance. This study aimed to evaluate the effect of automated oxygen titration compared to usual fixed-dose oxygen treatment during walking on dyspnea and endurance in patients with COPD and on LTOT. In a double-blinded randomised crossover trial, 33 patients were assigned to use either automated oxygen titration or the usual fixed-dose in a random order in two walking tests. A closed-loop device, O2matic delivered a variable oxygen dose set with a target saturation of 90-94%. The patients had a home oxygen flow of (mean ± SD) 1.6 ± 0.9 L/min. At the last corresponding isotime in the endurance shuttle walk test, the patients reported dyspnea equal to median (IQR) 4 (3-6) when using automated oxygen titration and 8 (5-9) when using fixed doses, p < 0.001. The patients walked 10.9 (6.5-14.9) min with automated oxygen compared to 5.5 (3.3-7.9) min with fixed-dose, p < 0.001. Walking with automated oxygen titration had a statistically significant and clinically important effect on dyspnea. Furthermore, the patients walked for a 98% longer time when hypoxemia was reduced with a more well-matched, personalised oxygen treatment.

Keywords: O2matic; exercise; long-term oxygen treatment; physiotherapy; respiratory failure.

Conflict of interest statement

The principal investigator has no conflicts of interest. One of the investigators, EFH is the main inventor of O2matic and hold shares in O2matic Ltd. EFH were not involved in the data collection nor in the primary analysis of the data. O2matic Ltd is not involved in the study. Apart from the above conflict of interest, the remaining investigators have none.

Figures

Figure 1
Figure 1
Consort flow diagram showing numbers of participants at each visit. ESWT: endurance shuttle walk test, 6MWT: six-minute walk test.
Figure 2
Figure 2
Percentage of time spent in the different oxygen saturation intervals (SpO2) when walking with automated oxygen titration and fixed oxygen dose in (A) the ESWT and (B) the 6MWT. The exact percentage of time in the respective interval is added on top of each bar. ESWT: endurance shuttle walk test, 6MWT: six-minute walk test.
Figure 3
Figure 3
Oxygen saturation (SpO2) during (A) the ESWT using automated oxygen titration, (B) the ESWT using the usual fixed oxygen dose, (C) the 6MWT using automated oxygen titration, and (D) the 6MWT when using fixed oxygen dose. Data in panel (A,B) are presented as individual patients, represented with different colors, to visualise the individual walking time, and in panel (C,D) as median with 25–75% quartiles. ESWT: endurance shuttle walk test, 6MWT: six-minute walk test.

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