Hypoxemia severity and survival in ILD and COPD on long-term oxygen therapy - The population-based DISCOVERY study.

Whether long-term oxygen therapy (LTOT) improves survival in interstitial lung disease (ILD) is unclear. A recent study reported similar survival in ILD patients with severe hypoxemia on LTOT vs. moderate hypoxemia without LTOT, and proposed that LTOT could be indicated in ILD already at moderate hypoxemia. The aim of this study was to compare survival by severity of hypoxemia in patients with ILD and COPD, respectively, treated with LTOT. A population-based, longitudinal study of adults starting LTOT for ILD or COPD 1987-2018. Transplant-free survival was compared between moderate (PaO2 7.4-8.7 kPa) and severe (PaO2<7.4 kPa) hypoxemia using Cox regression, adjusted for age, sex, BMI, smoking status, WHO performance status, year of starting LTOT, diagnosis of heart failure, ischemic heart disease and diabetes mellitus. In total, 17,084 patients were included, with ILD and moderate (n = 470) or severe hypoxemia (n = 2,408), and COPD with moderate (n = 2,087) or severe hypoxemia (n = 12,119). Compared with in COPD, ILD patients on LTOT had lower transplant-free survival after one year (41.9 vs. 67.1%) and two years (20.3 vs. 46.5%). In COPD worse hypoxemia was associated with slightly increased risk of death/lung transplantation, aHR 1.07 (1.00-1.14), a difference not shown in ILD, aHR 0.91 (0.80-1.03). Transplant-free survival did not differ in ILD patients between moderate and severe hypoxia despite LTOT.

Palm A ，Ekström M 《-》

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

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. 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. 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. 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.

Harrison AC ，Robinson JF ，Tu L ，McDonald CF ，Khor YH ... -  《-》

Severity of acidosis affects long-term survival in COPD patients with hypoxemia after intensive care unit discharge.

Gungor S ，Kargin F ，Irmak I ，Ciyiltepe F ，Acartürk Tunçay E ，Atagun Guney P ，Aksoy E ，Ocakli B ，Adiguzel N ，Karakurt Z ... -  《International Journal of Chronic Obstructive Pulmonary Disease》

Lung transplantation and survival outcomes in patients with oxygen-dependent COPD with regard to their alpha-1 antitrypsin deficiency status.

Ekström M ，Tanash H 《International Journal of Chronic Obstructive Pulmonary Disease》

Long-term oxygen therapy in COPD: evidences and open questions of current indications.

Corrado A ，Renda T ，Bertini S 《-》