Original Title: Oxigenoterapia crónica a domicilio

Authors' objectives: Main objective: To update the scientific evidence concerning domiciliary oxygen therapy (DOT) in the treatment of chronic obstructive pulmonary disease and to determine how this therapy is being used in our context and its repercussions for the patient. Secondary objectives: Draw up recommendations for the use of this technology documented on the basis of scientific literature. Determine the current situation of this technology in the Basque Country. Summarise and disseminate information obtained from specialists involved in this subject: pneumologists, cardiologists, specialists in internal medicine and family doctors.

Authors' results and conclusions: Results deriving from the synthesis of scientific evidence. DOT must be recommended for any patient suffering from chronic pneumopathy who has a PaO2 equal to or lower tahn 55 mm of Hg, or with PaO2 of between 55 and 60 mm Hg when anyone of the following clinical pictures exists: pulmonary arterial hypertension, chronic cor pulmonale, congestive cardiac insufficiency, disturbances in the ECG such as P pulmonale or a P > 3 mm wave in derivations II, III or AVF, cardiac arrhythmias or polyglobulia. The treatment must have a minimum duration of 15 hours/day including the hours of sleep in all cases. The treatment must be established and controlled mainly by the neumology services in accordance with of the gasometry results. Although it is not the method one would choose in the initial prescription of DOT, the pulse oximeter could be used to momitor these patients. It is udesul in the detection of hypoxaemia and the determination of flow dosage. The oxygen dose administered is the one necessary to obtain s PaO2 of over 60 mm Hg. Results dereived from the survey. Around 2,000 patients were in treatment with chronic oxygen therapy in the Basque Country in MAy 1998, which means 94.7/100,000 inhabitants. 58% had been smokers (34% smoked one pack/day and 24% were smokers of two or more packs/day). When the survey was made, 9.6% confessed to continue smoking. The treatment is established after being admitted to hospital in 92% of cases and after the performance of a preliminary gasometry in 93.2% of cases. This treatment is prescribed by neumology services in 80% of cases, internal medicine in 11%, cardiology service in 5.2% and by other clinical services in 3.5% of cases. Periodic monitoring is performed in hospitals in 69% of patients, 21% are controlled in ambulatories and 12.7% in the primary health centers. These controls are carried out on a monthly basis in 12.5% of patients, on a quarterly basis in 37.5%, every six months this is assessed in 21.3% of patients and 7.7% of patients are monitored on a yearly basis. This monitoring work is made by the neumology service in 70.3% of cases, by cardiologists in 8.5% and family doctors in 18.4% of cases. The recommended consumption period by 71% of professionals is greater than 15 hours/day, a recommendation that is put into practice by 62.8% of patients. Taking these two factors into consideration, 29% of prescriptions and 37.2% of monitoring work would be incorrect. Therefore, it can be said tha 55.3% of cases the technology is used incorrectly. With regard to the improvement perceived in the quality of life after establishing the treatment, 43.9% of patients report that their admissions to hospital have decreased; 67.2% of the patients say that their quality of life has improved a lot or quite a lot, 22% notice little improvement and 11% nothing at all. 44.1% of patients report that they can carry out functions the they were not able to before.

Authors' recommendations: DOT is the treatment of respiratory insufficiency that must be established when other therapeutic alternatives are incapable of curing hypoxaemia. The improvement observed in these patients after the establishment of the treatment relates to the number of hours of consumption of oxygen per day. The prescription must be made on an individual basis. The collaboration of the patient and other members of his/her family is essential. The patient must stop smoking completely. In 55.3% of cases where the technology is used incorrectly due to errors in the prescription or monitoring, patients could gain greater benefit from the treatment. Information and education are important pillars in the appropriate use of this therapy and the role of professionals in obtaining the desired results is essential. It is necessary to reinforce the monitoring of this treatment by re-educating the patient. The establishment of the figure of the domiciliary visitor may increase the number of effective consumers. It would be advisable for the Health Department to establish regulations in the Basque Country to control the indications, administration and prescription of domiciliary oxygen therapy. In order to draw up these regulations it would be necessary to have the collaboration of members of the scientific societies involved.

Authors' methods: 1. Bibliograhpical search of the scientific literature relating to the subject in the following bibliographical databases: Medline, HealthStar, Cochrane Library, ACP-Journal, International Network of Agencies for Health Technology Assessment (INAHTA). (1990-1999). The key word used has been Oxygen Inhalation Therapy associated to any of the following: Prospective Studies, Compliance, Home Care Services, Patient Education, Long-term Oxygen Therapy, Randomized Controlled Trial, Quality of Life, Survival. Identification and selection of the most relevant articles relating to the subject. Studies in English, Spanish and French were selected from essays on random desing, clinical practice guidelines and documents drafted by evaluation agencies. Studies that assessed DOT in situations others other than chronic obstructive pulmonary disease were excluded. Articles expressing opinions on the subject and letters to the editor have also been rejected. After a critical appraisal of the literature, tables were drawn up summarising the scientific evidence. 2. Examination of hospital admissions by means of the MBDS-register of hospital admissions between 1994 and 1998 of the ICD-9-CM: 491, 492, 493-2, 496. 3. Patient-focused survey aimed at determining compliance, indication, control, oxygen system used and patient satisfaction.

Project Status: Completed

Year Published: 1999

URL for published report: https://www.euskadi.eus/contenidos/informacion/1999_osteba_publicacion/es_def/adjuntos/1999/d_99_02_oxigenoterapia_cronica.pdf

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment), Health Department of the Basque Government</p>