4. Case 1 (1)
65-årig kvinde m. KOL eksacerbation.65-årig kvinde m. KOL eksacerbation.
Indlagt på 5. døgn. Overvejer udskrivelse.Indlagt på 5. døgn. Overvejer udskrivelse.
Uden ilttilskud: POUden ilttilskud: PO22=6.5 & PCO=6.5 & PCO22=5.8 kPa=5.8 kPa
Skal hun starte kronisk iltbehandling?Skal hun starte kronisk iltbehandling?
Hvad gør du?Hvad gør du?
5. Case 1 (2)
Hvis JaHvis Ja:
Pt. er motiveret for brug >15 timer dagl.Pt. er motiveret for brug >15 timer dagl.
Ikke-rygerIkke-ryger
Iltflow: eleverer POIltflow: eleverer PO22 >8.0 el. min. 0.7 kPa>8.0 el. min. 0.7 kPa
Sikre sig imod betydende hyperkapniSikre sig imod betydende hyperkapni
IltsystemerIltsystemer
Inform. pt. om evt. temporær LTOT (kontrol)Inform. pt. om evt. temporær LTOT (kontrol)
Kontrol efter 1-3 mdr.Kontrol efter 1-3 mdr.
Hvis Nej:Hvis Nej: Kontrol efter 1-3 mdr.Kontrol efter 1-3 mdr.
6. Case 1 (3)
Ved 3-mdr.-kontrol:Ved 3-mdr.-kontrol:
POPO22=7.6 & PCO=7.6 & PCO22=5.6 kPa.=5.6 kPa.
Dyspnø ved let-moderat anstrengelse.Dyspnø ved let-moderat anstrengelse.
Angiver subjektiv effekt af iltAngiver subjektiv effekt af ilt
Skal LTOT fortsætte?Skal LTOT fortsætte?
10. COT in non-COPD
Lung fibrosis: 62 patients. No effect on survival.
Unpublished data.
Crockett AJ et al. Domiciliary oxygen for interstitial lung
disease. Cochrane Database Syst Rev 2001; 3:CD002883
11. RCT on moderate hypoxaemic
COPD patients
1987-92 in Poland1987-92 in Poland
135 COPD patients with P135 COPD patients with PaaOO22 7.4-8.7 kPa.7.4-8.7 kPa.
Post-PO2 >8.7 kPa (mean 9.9 kPa)Post-PO2 >8.7 kPa (mean 9.9 kPa)
>17 hrs/day vs. no oxygen (used 13½ hrs)>17 hrs/day vs. no oxygen (used 13½ hrs)
Only concentratorOnly concentrator
Not assessed:Not assessed:
QoLQoL
Daily activity/exerciseDaily activity/exercise
HospitalisationHospitalisation
14. Aims of portable and ambulatory oxygen
Portable Oxygen (hypoxaemic at rest)
↑hrs on oxygen
↑daily activity
Ambulatory Oxygen (normoxaemic at rest)
Desaturate and/or dyspnoea during exercise
↑exercise tolerance/daily activity
15. Effect and usage of portable oxygen in
COPD pts on COT
COT: 3-12 months
Excluded pts. who were not
expected to live > 1 year.
Conc.: 3 mdr. Conc.
+O2: 3 mdr. Conc.-O2:
3 mdr.
Lacasse Y, ERJ 2005
16. Effects and use of portable (3½ kg) oxygen in
24 COPD pts on LTOT. 3 x 3 months
•No effect on QoL and 6 MWD
Lacasse Y, ERJ 2005
17. Portable oxygen in 930 COPD pts on COT
France before 1996; Presc. 16 hrs/day; COT >3 months
Portable oxygen to 30% of 893 ptt. with a concentrator.
Only used by 52% in a 3 months period
Only used outdoor by 4% –
especially those with liquid oxygen
Pepin JL et al. Chest 1996
19. STOT (oxygen at home while unstable)
Re-evaluation:
1 month later: normalised in 30%1
and 70%2
2-3 months later: 30-50% normalised1,3
PO2<6.7 kPa: only 1 of 23 normalised1
Despite LTOT: 17% died <2 months4
No RCT
1) Levi-Valensi et al. Am Rev Respir Dis 1986
2) Andersson et al. Respir Med 2002
3) NOTT study
4) Eaton et al. Respir Med 2001
21. SBOT
(palliation of attacks of dyspnoea)
Very few studies1,2
Only mentioned superficially in BTS, ATS, GOLD
COPD: 6-12 wks: 4 studies (PO2 8.5-10 kPa):
2 showed a small effect compared to air.
Cancer:
+hypoxaemia at rest: 5 L O2/min > air.
- hypoxaemia at rest: 4 L O2/min= 4 L air/min
1) Booth S et al.Respir Med 2004
2) Booth S et al. Am J Respir Crit Care Med 1996
22. The Terminology of
Home Oxygen Therapy
Ingen effekt på overlevelse eller udvikling af PAP el. ”daytime hypoxaemia”
26. Start LTOT
Ca. 80% starter LTOT efter indl.
30-50% har “normaliseret” PO2 efter 3 mdr.
Information
Oxygen-system(er) herunder bærbar ilt
27. Kontrol
Sat. (-OSat. (-O22) (hvis >88%, da a-punktur)) (hvis >88%, da a-punktur)
Bestemme ilt-flowBestemme ilt-flow
Sikre ikke-ryger statusSikre ikke-ryger status
Sikre kompliance (15-24 timer)Sikre kompliance (15-24 timer)
Behov for oxygen-systemerBehov for oxygen-systemer
Evt. hjemme-visitEvt. hjemme-visit
28. Smoking and COT
Effect? Probably
15-24 hrs/day? Not possible for heavy smokers
Safe? Not everybody
Ethical aspects? Seretide to smokers?
29. Effect of oxygen and CO on
12-minute walking distance
Calverley PMA, BMJ 1981
580
600
620
640
660
680
700
720
740
760
Air Oxygen Air+CO Oxygen+CO
12-MWD
meter p<0.01 p<0.01 p<0.01
15 COPD; FEV1=0.56 L; PO2: 5.2-7.7 kPa
30. Kvaliteten af behandlingen (KOL)
Ca. 20% ryger (måske flere)
Ca. 50% har ikke iltmangel konstant
Ca. 60% ses ambulant
0
10
20
30
40
50
60
70
80
90
100
01.11.9431.12.9531.12.9631.12.9731.12.9831.12.9931.12.00
%
Oxygen
concentrator or
liquid oxygen
15-24 hrs/day
Mobile oxygen
31. Patient karakteristika
KOL: ca. 75%
Lungekræft: ca. 10%
Lungefibrose: ca. 5%
Hjertelidelse: ca. 5%
Neuromuskulær-lidelse/kyfoskoliosis: ca. 5%
Kvinder: ca. 60%
Flow: 1.4 L/min.
Alder: 72 år
32. Praktiske forhold ved LTOT
Hvordan ordineres LTOT?
Fugtet luft?
Pulssaturation versus a-punktur?
Rejser inden- og udenlands?
33. Prevalence of HOT in
various countries (per 100.000)
0
10
20
30
40
50
60
70
80
90
100
1987 1993 2006 2010
DK
SE
F
N
35. Survival rates of new COPD patients on COT from
Denmark compared to patients from other countries
0
10
20
30
40
50
60
70
80
90
100
0 3 6 9 12 15 18 21 24 27 30 33 36 39
Months
Cumulativesurvivalproportion(%)%)
Denmark (n=5659)
Sweden (n=403)
Belgium (n=270)
France (n=252)
Australia (n=505)
NOTT, COT (n=101)
Japan (n=4552)
37. Conclusions
COT improves survival in hypoxaemic patients
Most patients started after hospitalisation
Only about 50% are followed up
Portable oxygen is still too heavy
↑ incidence and prevalence
In general, poor survival
Thank you for your attention
Editor's Notes
In 1994 the prevalence of COPD was about 27/100.000. I the following years, it increased by about 50% to 42/100.000
The incidence of COPD increased from 20 to 25/100.00 during 5 years