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 ... -  《-》

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 《-》

Predictors of Impaired Survival in Subjects With Long-Term Oxygen Therapy.

The need for long-term oxygen therapy (LTOT) is usually a sign of advanced disease, which could trigger advance care planning. However, LTOT is used in patients with different characteristics and multiple diagnoses beyond COPD. We studied the factors associated with survival in an unselected sample of subjects who started LTOT. We conducted a retrospective study that included 195 subjects for whom LTOT was initiated in Tampere University Hospital from January 1, 2012, to December 31, 2015, and followed up until December 31, 2017. The most frequent diseases that caused the need for LTOT were COPD and interstitial lung diseases. Most of the subjects (69%) died during the study period; the median survival time was 2.2 y. The subjects with interstitial lung disease as a primary disease for LTOT had a shorter survival time (median 0.9 y) compared with those with COPD (median 2.4 y, P < .001). Survival was shorter in the subjects ages >75 y (median 1.4 y) compared with those who were ages ≤75 y (median 2.8 y, P = .001) and also in those who required help with daily activities (median 1.2 y) compared with those who did not (median 3.3 y, P < .001). In multivariate analysis, a diagnosis of interstitial lung disease (hazard ratio 2.1, 95% CI 1.4-3.2), Charlson comorbidity index (hazard ratio 1.26, 95% Cl 1.11-1.43), and required help in activities of daily living (hazard ratio 2.1, 95% CI 1.4-3.1) were associated with impaired survival. The survival of the subjects who started LTOT varied greatly. The subjects with interstitial lung disease and those who required assistance with activities of daily living were at risk of dying in ∼1 y, which suggested that advance care planning should be directed especially to these patients.

Rantala HA ，Leivo-Korpela S ，Lehtimäki L ，Lehto JT ... -  《-》

Driving performance in patients with chronic obstructive lung disease, interstitial lung disease and healthy controls: a crossover intervention study.

Skovhus Prior T ，Troelsen T ，Hilberg O 《BMJ Open Respiratory Research》

End-of-life care in oxygen-dependent ILD compared with lung cancer: a national population-based study.

Advanced fibrosing interstitial lung disease (ILD) is often progressive and associated with a high burden of symptoms and poor prognosis. Little is known about the symptom prevalence and access to palliative care services at end of life (EOL). Compare prevalence of symptoms and palliative treatments between patients dying with oxygen-dependent ILD and patients dying of lung cancer. Nationwide registry-based cohort study of patients with oxygen-dependent ILD and patients with lung cancer who died between 1 January 2011 and 14 October 2013. Prevalence of symptoms and treatments during the last seven days of life were compared using data in Swedish Registry of Palliative Care. 285 patients with ILD and 10 822 with lung cancer were included. In ILD, death was more likely to be 'unexpected' (15% vs 4%), less likely to occur in a palliative care setting (17% vs 40%) and EOL discussions with the patients (41% vs 59%) were less common than in lung cancer. Patients with ILD suffered more from breathlessness (75% vs 42%) while patients with lung cancer had more pain (51% vs 73%) (p<0.005 for all comparisons). Patients with ILD had more unrelieved breathlessness, pain and anxiety. The survival time from initiation of oxygen therapy in ILD was a median 8.4 months (IQR 3.4-19.2 months). Patients with ILD receive poorer access to specialist EOL care services and experience more breathlessness than patients with lung cancer. This study highlights the need of better EOL care in oxygen-dependent ILD.

Ahmadi Z ，Wysham NG ，Lundström S ，Janson C ，Currow DC ，Ekström M ... -  《-》