Automated Oxygen Delivery in Home Setting for Patients with COPD on Long-Term Oxygen Therapy – a randomized crossover feasibility trial

Rationale Patients with COPD on long-term oxygen therapy (LTOT) have an unmet need for oxygen adjustments during sleep, rest, and activity, documented by continuous monitoring of oxygen saturation. While emerging technology enables automated adjustments, its feasibility in home settings remains uncertain. This randomized crossover trial evaluated the feasibility and preliminary effects of continuous automated oxygen titration in the homes of patients on LTOT.Methods The intervention involved four days of automated oxygen titration targeting a SpO₂ of 90-94% using a Bluetooth-connected electronic device and wrist pulse oximeter, forming a closed-loop system. Oxygen flow (0.9-6.8 L/min) was continuously adjusted based on SpO₂. During the control period, patients received their usual fixed dose oxygen. Feasibility was defined as successful automated titration time and time spent with normoxia. Changes in health status were measured using the Clinical COPD Questionnaire (CCQ).Results Twelve patients on LTOT (2.0±0.8 L/min) were included, with more than 217,000 paired SpO2 and oxygen flow data points collected per patient. Oxygen flow was automatically adjusted for a median (IQR) of 77 (68.0–84.3) hours, covering 83% of the time. Time within target saturation increased significantly from 52% (42–63) to 86% (75–90) during intervention, with all patients utilizing the full available flow range. The CCQ score improved by 0.74±0.47 points, p <0.001.Conclusion Automated home oxygen titration is feasible, achieving more time with normoxia, but it required a wide flow range and continuous monitoring. The patients reported notable reductions in COPD symptoms.Competing Interest StatementThe principal investigator has no conflicts of interest. One of the investigators (Ejvind Frausing Hansen) is a co-inventor of the closed-loop device and holds shares in O2matic Ltd. Neither the company nor the funders had influence on the protocol, the data analysis, or the writing of the scientific paper. Apart from the above conflict of interest the remaining investigators have none.Clinical TrialNCT0555618

Effect of automated oxygen titration during walking on dyspnea and endurance in chronic hypoxemic patients with copd:A randomized crossover trial

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

Optimised oxygenation improves functional capacity during daily activities in patients with COPD on long-term oxygen therapy – a randomised crossover trial

Background Minimising hypoxemia during submaximal walking tests has a positive effect on exercise capacity and dyspnea in patients with COPD on long-term oxygen therapy (LTOT). However, the impact of optimising oxygenation during everyday tasks remains unexplored. Therefore, we investigated the effects of maintaining a target saturation on activities of daily living (ADL) using automated oxygen titration compared to conventional fixed oxygen flow.Methods In a double-blinded, randomised crossover trial, 31 patients with COPD on LTOT performed two GlittreADL tests to assess the functional capacity of everyday activities using a) their fixed oxygen dose and b) an adjusted flow from 0-8 L/min targeting a SpO2 of 90-94%. A closed-loop device automatically titrated the oxygen based on information from a Bluetooth wrist pulse oximeter.Results The patients reduced the time to perform the ADL-test by median (IQR) 38 (12–73) seconds, p&lt;0.001, using automated titration compared to the fixed oxygen flow. The oxygen flow in the automated arm more than tripled to 5.4 (4.1–6.8) vs. 1.6 (1.1–2.1) L/min (fixed) during the test, p&lt;0.001, while the time spent within SpO2-target was increased from 19% to 49%, p=0.002. Correspondingly, the patients experienced less dyspnea (BorgCR10); 5 (3–7) vs. 6 (4–8), p&lt;0.001, in favour of the automated oxygen titration.Conclusions Improving oxygenation and extending the time spent within target saturation reduced dyspnea and improved functional capacity in activities of daily living in patients with COPD on LTOT.Trial registration number NCT0555384

Guideline for the management of COVID-19 patients during hospital admission in a non-intensive care setting

Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has presented health-care systems worldwide with novel challenges and experiences and evidence is emerging during the pandemic. Patients requiring hospitalization frequently suffer from respiratory failure of different severities. Aim: The aim of this guideline is the treatment of patients with SARS CoV-2 (COVID-19) in hospital; in particular, it addresses the treatment of respiratory failure treated in general Internal Medical- and Pulmonary Medical wards. Results: Elderly patients and patients with chronic disease are particularly vulnerable to COVID-19. Target oxygen saturation should be between 92% and 96% in patients without chronic lung diseases. Treatment with &gt;5 L oxygen/min should be in close collaboration with intensive care colleagues and &gt;15 l/min preferably in intensive care units. High-flow nasal canula (HFNC) and long-term Continuous Positive Airway Pressure (CPAP) are recommended for patients not responding to conventional oxygen therapy. Non-invasive ventilation (NIV) is only recommended for selected patients, such as those with a ceiling of treatment or patients presenting with hypercapnic failure. With the use of humidification protective equipment as FFP2-3 masks should be used. Nebulized medication should be avoided, and spacers should be used instead. Conclusion: Respiratory failure is frequently the cause of hospitalization in patients with COVID-19 and should be monitored closely.</p

Home Non Invasive Ventilation (NIV) treatment for COPD patients with a history of NIV-treated exacerbation:a randomized, controlled, multi-center study

BACKGROUND: In chronic obstructive pulmonary disease, the prognosis for patients who have survived an episode of acute hypercapnic respiratory failure due to an exacerbation is poor. Despite being shown to improve survival and quality-of-life in stable patients with chronic hypercapnic respiratory failure, long-term noninvasive ventilation is controversial in unstable patients with frequent exacerbations, complicated by acute hypercapnic respiratory failure. In an uncontrolled group of patients with previous episodes of acute hypercapnic respiratory failure, treated with noninvasive ventilation, we have been able to reduce mortality and the number of repeat respiratory failure and readmissions by continuing the acute noninvasive ventilatory therapy as a long-term therapy. METHODS: Multi-center open label randomized controlled trial of 150 patients having survived an admission with noninvasive ventilatory treatment of acute hypercapnic respiratory failure due chronic obstructive pulmonary disease. The included patients are randomized to usual care or to continuing the acute noninvasive ventilation as a long-term therapy, both with a one-year follow-up period. The primary endpoint is time to death or repeat acute hypercapnic respiratory failure; secondary endpoints are one-year mortality, number of readmissions and repeat acute hypercapnic respiratory failure, exacerbations, dyspnea, quality of life, sleep quality, lung function, and arterial gases. DISCUSSION: Though previous studies of long-term noninvasive ventilation have shown conflicting results, we believe the treatment can reduce mortality and readmissions when applied in patients with previous need of acute ventilatory support, regardless of persistent hypercapnia. TRIAL REGISTRATION: clinicaltrials.org: NCT01513655 16-Jan-2012

The Experience of Automated Home Oxygen Therapy for Patients With COPD–A Qualitative Study

The present study included the first patients with COPD on long-term oxygen therapy who experienced second-by-second oxygen adjustments in their homes based on oxygen saturation. A device capable of automatically titrating the patient’s oxygen was installed in the patients’ home aiming at increasing the time spent within target saturation. We explored patients’ experiences with this automated home oxygen titration, focusing on how maintaining target saturation affected daily life. Semi-structured interviews were conducted with eight men and four women after installation. Systematic text condensation was used in the analysis. Three main themes emerged from patient narratives: (1) “This is my life”–Patients preferred maintaining stable oxygen saturation, associating hypoxemia with dyspnea, discomfort, and difficulties with daily tasks. (2) “Getting the oxygen, I need”–Many patients reported improved ability to perform daily activities when oxygen was automatically adjusted. (3) “New technology gives hope for my life”–Patients expressed optimism about the potential of home-based technology, offering suggestions to improve usability, mainly by reducing concentrator noise. Our findings suggested high acceptability of the automated oxygen in the patients’ home, as they believed it to increase the time spend with sufficient oxygen, especially during daily activities. Integrating patient insights is essential for implementation and acceptance of automated home oxygen therapy

The Experience of Automated Home Oxygen Therapy for Patients with COPD – a Qualitative Study

The present study included the first patients with COPD on long-term oxygen therapy who experienced second-by-second oxygen adjustments in their homes based on oxygen saturation. A device capable of automatically titrating the patient’s oxygen was installed in the patients’ home aiming at increasing the time spent within target saturation. We explored patients’ experiences with this automated home oxygen titration, focusing on how maintaining target saturation affected daily life.Semi-structured interviews were conducted with eight men and four women after installation. Systematic text condensation was used in the analysis.Three main themes emerged from patient narratives: 1) “This is my life” – Patients preferred maintaining stable oxygen saturation, associating hypoxemia with dyspnea, discomfort, and difficulties with daily tasks. 2) “Getting the oxygen, I need” – Many patients reported improved ability to perform daily activities when oxygen was automatically adjusted. 3) “New technology gives hope for my life” – Patients expressed optimism about the potential of home-based technology, offering suggestions to improve usability, mainly by reducing concentrator noise.Our findings suggested high acceptability of the automated oxygen in the patients’ home, as they believed it to increase the time spend with sufficient oxygen, especially during daily activities. Integrating patient insights is essential for implementation and acceptance of automated home oxygen therapy.Clinical TrialNCT0555618