COPD Management News and Views

Specialist supplemental oxygen therapy is the only existing approach shown to modify the long-term decline in lung function associated with COPD. LTOT is associated with a variety of other benefits in patients with severe COPD including increased survival, reduced secondary polycythemia, increased cardiac function during rest and exercise and improved exercise tolerance. 1,2

Up until the first of February 2006 in England and Wales home oxygen could only be prescribed by primary care physicians. Unfortunately a lot of patients were prescribed oxygen for relief of symptoms of breathlessness without ever having had a formal oxygen assessment. Much of this oxygen was given in the form of cylinders for PRN usage (short burst oxygen therapy – SBOT) a costly provision without good evidence of efficacy of this treatment.

Historically patients within this locality requiring Long Term Oxygen Therapy (LTOT) were assessed within the acute Trust. These oxygen assessments were traditionally based upon availability of ward based beds or occasionally clinic based assessments. These assessment services were not funded as a separate service proving to be spasmodic and unstructured with poor or no follow up monitoring. In addition there is no formal ambulatory oxygen service within this locality which has proven to be a costly and growing service with portable oxygen cylinders supplied to patients as a “want” rather than “need” service.

The implementation of the new oxygen contract has highlighted that appropriate assessment is essential so that patients are treated with home oxygen for the right period of time and with appropriate flow rates to obtain optimal benefits and reduce chances of adverse events.

An attempt to rationalise oxygen prescribing by reviewing oxygen assessments at home was explored within NHS Hull by introducing the i-STAT portable gas analyser for home based blood gas assessments, monitoring and treating patients at the point of care.

The hand held i-STAT enables respiratory nurses to monitor the status of respiratory patients within minutes when conducting home visits. This means informed decisions on accurate oxygen prescribing and the need to prevent hospital admission to undergo further assessment. It also means less anxiety and inconvenience for patients, who can find out test results on the spot.

Using advanced biosensor technology and as little as two drops of capillary blood from the ear can deliver accurate testing for blood gases.

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Filed under: COPD-Related News