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Research ArticleOriginal Research

Multidisciplinary Care and Prognosis in Patients With COPD and Interstitial Lung Disease Prescribed Long-Term Oxygen Therapy

Amelia CA Harrison, Julien F Robinson, Laura Tu, Christine F McDonald and Yet Hong Khor
Respiratory Care June 2022, 67 (6) 667-675; DOI: https://doi.org/10.4187/respcare.09446
Amelia CA Harrison
Department of Respiratory and Sleep Medicine, Austin Health, Victoria, Australia; and Institute for Breathing and Sleep, Victoria, Australia.
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Julien F Robinson
Department of Respiratory and Sleep Medicine, Austin Health, Victoria, Australia; and Institute for Breathing and Sleep, Victoria, Australia.
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Laura Tu
Department of Respiratory and Sleep Medicine, Austin Health, Victoria, Australia.
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Christine F McDonald
Department of Respiratory and Sleep Medicine, Austin Health, Victoria, Australia; Institute for Breathing and Sleep, Victoria, Australia; and Faculty of Medicine, University of Melbourne, Victoria, Australia.
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Yet Hong Khor
Department of Respiratory and Sleep Medicine, Austin Health, Victoria, Australia; Institute for Breathing and Sleep, Victoria, Australia; and Faculty of Medicine, University of Melbourne, Victoria, Australia.
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Abstract

BACKGROUND: Home oxygen therapy is prescribed for patients with advanced lung disease based on the criteria established in landmark trials in subjects with COPD. In clinical practice, its use has been extrapolated to other diseases, including interstitial lung disease (ILD). Patients with COPD and ILD experience a high symptom burden and require access to specialized multidisciplinary care. We aimed to evaluate the health-related outcomes and supportive care needs of patients with COPD and ILD receiving home oxygen therapy.

METHODS: This was a retrospective cohort study using the oxygen database of a quaternary metropolitan teaching hospital. Patients with a diagnosis of COPD or ILD who were prescribed home oxygen therapy between January 2012–December 2018 were identified. Demographic information, results of physiologic testing, comorbidities, hospitalizations, and mortality data were collected.

RESULTS: Three hundred and eighty-four subjects were included for analysis, of whom 56% were male. The median age was 75 y. The majority (59%) had a diagnosis of COPD. Long-term oxygen therapy (LTOT) was prescribed for 187 (48.7%), with no significant demographic differences between those with COPD or ILD. Another 187 were prescribed ambulatory oxygen alone, with 55 transitioning to LTOT during the study period. Most subjects (65.4%) were referred for pulmonary rehabilitation; however, palliative care referrals were generally low (22.9%). Referrals to other medical specialties and allied health were common (82%). Transplant-free survival after commencement of LTOT was poor, with 38% of subjects surviving at 5 y. The 5-y survival of subjects with ILD after commencing on LTOT was 10% compared to 52% for those with COPD. Multivariable Cox regression analyses showed that the only predictor of survival after commencing LTOT was the principal respiratory diagnosis.

CONCLUSIONS: This study found that subjects prescribed LTOT had poor transplant-free survival after initiation, which was significantly worse for those with ILD compared to those with COPD. Despite their poor overall survival, worse than many cancers, only a minority were referred for palliative care input. Referrals to pulmonary rehabilitation were also suboptimal. This patient population had complex care needs requiring multidisciplinary management. Appropriate and early referrals to palliative care and improved care coordination for this complex group of patients are key areas for improvement in clinical practice.

  • ambulatory oxygen therapy
  • long-term oxygen therapy
  • interstitial lung disease
  • COPD

Footnotes

  • Correspondence: Dr Yet H Khor MBBS (Hons) BMedSci FRACP PhD, Department of Respiratory and Sleep Medicine, Austin Health, 145 Studley Road, Heidelberg 3084 VIC. E-mail: yethong.khor{at}austin.org.au
  • Dr Khor discloses relationships with Air Liquide Healthcare, Boehringer Ingelheim, and Roche. Dr McDonald discloses relationships with Air Liquide Healthcare and Menarini. The remaining authors have disclosed no conflicts of interest.

  • Portions of this work were presented at the Thoracic Society of Australia and New Zealand Annual Scientific Meeting 2021, held virtually May 2021.

  • This study was performed at the Department of Respiratory and Sleep Medicine, Austin Health, Victoria, Australia.

  • Copyright © 2022 by Daedalus Enterprises
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Respiratory Care: 67 (6)
Respiratory Care
Vol. 67, Issue 6
1 Jun 2022
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Multidisciplinary Care and Prognosis in Patients With COPD and Interstitial Lung Disease Prescribed Long-Term Oxygen Therapy
Amelia CA Harrison, Julien F Robinson, Laura Tu, Christine F McDonald, Yet Hong Khor
Respiratory Care Jun 2022, 67 (6) 667-675; DOI: 10.4187/respcare.09446

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Multidisciplinary Care and Prognosis in Patients With COPD and Interstitial Lung Disease Prescribed Long-Term Oxygen Therapy
Amelia CA Harrison, Julien F Robinson, Laura Tu, Christine F McDonald, Yet Hong Khor
Respiratory Care Jun 2022, 67 (6) 667-675; DOI: 10.4187/respcare.09446
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Keywords

  • ambulatory oxygen therapy
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  • interstitial lung disease
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