Current Situation of Home Oxygen Therapy for Chronic Obstructive Pulmonary Disease Patients in Korea

Effect evaluation of six-character exercise breathing assisted long-term home oxygen therapy in patients with chronic obstructive pulmonary disease / 中国实用护理杂志

Objective@#To evaluate the effect of six-character formula breathing exercises combined with long-term home oxygen therapy in the rehabilitation of patients with chronic obstructive pulmonary disease (COPD).@*Methods@#A total of 200 COPD patients in Shanghai First People′s Hospital were divided into control group and observation group by odd and even numbers with 100 cases each. The patients in control group received routine long-term home oxygen therapy and the patients in observation group received six-character formula breathing exercises as an adjunct to long-term home oxygen therapy. The patients completed the Modified Medical Research Council (mMRC) score at 1 month, 3 months and 9 months respectively. At 6 months and 12 months, the patients completed the mMRC score, the frequency of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), the number of re-admissions, the partial pressure of carbon dioxide in arterial blood (PaCO2) and St. George′s Respiratory Disease Questionnaire (SGRQ) scores. At 12 months, the patients were evaluated for the six-minute walking test.@*Results@#The duration of oxygen in observation group was (6.3 ± 1.7) h/d, was shorter than control group (7.5 ± 2.1) h/d (t=2.040, P=0.043). The frequency of AECOPD in observation group at 12 months was (3.12 ± 0.49) times/case, was lower than control group (4.95±0.65) times/case (t= 22.482, P <0.01). The frequency of re-admission in observation group was (1.09 ± 0.41) times/case, was lower than control group (1.22 ± 0.39) times/case (t= 2.215, P=0.028). The mMRC scores in observation group at 3 months and 9 months was (2.733±0.750), (2.749 ± 0.938), was lower than control group (3.186 ± 0.734), (3.197 ± 0.848) (t=4.317, 3.543, P<0.01). The SGRQ scores in observation group at 6 months and 12 months was (54.678 ± 9.318), (56.656 ± 7.294), was lower than control group (61.603 ± 8.989), (63.006 ± 7.387) (t=5.349, 6.117, P<0.01). PaCO2 in observation group at 12 months was (6.422 ± 0.864) kPa, was better than control group (6.856 ± 0.904) kPa (t=3.471, P=0.01). The walking distance of 6 minutes in observation group was (265.483 ± 19.277) meters, was longer than control group (232.966 ± 18.883) meters (t= 12.050, P < 0.01).@*Conclusions@#Six-character formula breathing exercises assisted with long-term home oxygen therapy can reduce the use of oxygen, reduce the frequency of AECOPD and readmission, improve the symptoms of COPD patients, and delay the pathological process of COPD.

Effect evaluation of six-character exercise breathing assisted long-term home oxygen therapy in patients with chronic obstructive pulmonary disease / 中国实用护理杂志

Objective To evaluate the effect of six-character formula breathing exercises combined with long-term home oxygen therapy in the rehabilitation of patients with chronic obstructive pulmonary disease (COPD). Methods A total of 200 COPD patients in Shanghai First People′s Hospital were divided into control group and observation group by odd and even numbers with 100 cases each. The patients in control group received routine long-term home oxygen therapy and the patients in observation group received six-character formula breathing exercises as an adjunct to long-term home oxygen therapy. The patients completed the Modified Medical Research Council (mMRC) score at 1 month, 3 months and 9 months respectively. At 6 months and 12 months, the patients completed the mMRC score, the frequency of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), the number of re-admissions, the partial pressure of carbon dioxide in arterial blood (PaCO2) and St. George′s Respiratory Disease Questionnaire (SGRQ) scores. At 12 months, the patients were evaluated for the six-minute walking test. Results The duration of oxygen in observation group was (6.3 ± 1.7) h/d, was shorter than control group (7.5 ± 2.1) h/d (t =2.040, P =0.043). The frequency of AECOPD in observation group at 12 months was (3.12 ± 0.49) times/case, was lower than control group (4.95±0.65) times/case (t=22.482, P<0.01). The frequency of re-admission in observation group was (1.09 ± 0.41) times/case, was lower than control group (1.22 ± 0.39) times/case (t=2.215, P=0.028). The mMRC scores in observation group at 3 months and 9 months was (2.733±0.750), (2.749 ± 0.938), was lower than control group (3.186 ± 0.734), (3.197 ± 0.848) (t=4.317, 3.543, P<0.01). The SGRQ scores in observation group at 6 months and 12 months was (54.678 ± 9.318), (56.656 ± 7.294) , was lower than control group (61.603 ± 8.989), (63.006 ± 7.387) (t=5.349, 6.117, P<0.01). PaCO2 in observation group at 12 months was (6.422 ± 0.864) kPa, was better than control group (6.856 ± 0.904) kPa (t=3.471, P=0.01). The walking distance of 6 minutes in observation group was (265.483 ± 19.277) meters, was longer than control group (232.966 ± 18.883) meters (t = 12.050, P <0.01). Conclusions Six-character formula breathing exercises assisted with long-term home oxygen therapy can reduce the use of oxygen, reduce the frequency of AECOPD and readmission, improve the symptoms of COPD patients, and delay the pathological process of COPD.

Management of home oxygen therapy on bronchopulmonary dysplasia in preterm imfants after discharge / 国际儿科学杂志

Bronchopulmonary dysplasia(BPD) was a severe chronic respiratory disease in preterm infants.In recent years,the incidence of BPD increased annually with the increased survival rate of preterm infants.Some patients were oxygen-dependent due to their pulmonary dysfunction.In these patients,a scientific and sound domiciliary oxygen therapy protocol could shorten the hospital stay,reduce expenditure and prevent nosocomial infection and relative complications.This article would discuss in detail about the domiciliary oxygen therapy,including the preparation,protocol,domestic nutrition and follow-up as well as the prevention of sudden infant deaths.

Case of Advanced COPD: Lessons Learnt

@#A case study of a 76-year-old man with end-stage chronic obstructive pulmonary disease (COPD) with refractory breathlessness and the challenges in managing the dyspnoea he had been experiencing are described. A multi-modal approach is the mainstay of management, encompassing pharmacological agents, home oxygen therapy, and non-pharmacological approaches, namely, breathing techniques and smoking cessation. As this patient was at an advanced stage of disease, integration of palliative care with disease care was needed. Administering oxygen therapy for a patient who is still smoking and has household members who are current smokers need firm adherence to rules. The AIC HOME Programme is also briefly described.

Oxigenoterapia Crónica Domiciliaria en el Noroeste Argentino, situación actual y propuestas de solución / Chronic Domiciliary Oxygen Therapy in Argentina's Northwest, Current Situation and Possible Solutions

Introducción: La Oxigenoterapia Crónica Domiciliaria (OCD) es una modalidad terapéutica con efectos beneficiosos conocidos y avalados por evidencia científica en pacientes con insuficiencia respiratoria crónica en estado estable. En nuestro medio existen controversias relacionadas con su "uso incorrecto" atribuible quizás a la falta de un marco regulatorio actualizado y un sistema de registro nacional, tal como fue recomendado por el consenso argentino de OCD. Se consideró hacer un diagnóstico de situación en la Región Noroeste Argentino (NOA) de la AAMR para elaborar propuestas concretas a futuro. Material y Métodos: Se realizó una investigación descriptiva en la Región NOA. Se determinó como población de referencia los tres sectores involucrados en la prestación de OCD: neumonólogos de la Región, delegados locales de las principales empresas proveedoras de oxígeno medicinal y representantes de los tres subsistemas de salud. Se aplicaron encuestas y entrevistas especialmente diseñadas. Resultados: 65 neumonólogos del NOA respondieron la encuesta, un 71% del total de los especialistas registrados en la AAMR. 91% prescribe OCD con un promedio de 11 pacientes por cada profesional, siendo la insuficiencia respiratoria por EPOC el diagnóstico más frecuente como indicación de oxigenoterapia. 54% considera que el equipo adjudicado al paciente no se ajusta al que prescribió. En una de las provincias se autoriza la prescripción a médicos no neumonólogos. Los representantes de las empresas proveedoras de oxígeno respondieron que trabajan según normativas de ANMAT y acorde a legislación nacional vigente. Se entrevistó a 52 obras sociales y prepagas y a tres sistemas de gestión estatal. En los subsistemas de salud la posición ante la cobertura de OCD es desigual y no poseen base de datos de pacientes con oxigenoterapia. Todos coincidieron en la necesidad de unificar las normativas y proponer un marco regulatorio único. Conclusión: El diagnóstico de situación sobre la prescripción y prestación de la oxigenoterapia en el NOA señala la falta de un marco regulatorio que contemple todos los aspectos de la OCD. Las normativas existentes no son suficientes para la correcta utilización de la terapéutica y la implementación de las recomendaciones del consenso argentino no fueron las esperadas. El grupo de trabajo elaboró propuestas como actualización del Consenso Nacional de OCD, creación de un Sistema Nacional de Registro y confección de un "Instrumento Legal" que respalde el tratamiento con oxígeno, medidas destinadas a una distribución más equitativa de los gastos en Salud.

Introduction: Chronic Domiciliary Oxygen Therapy (OCD) is a therapeutic modality with beneficial effects known and supported by scientifc evidence in patients with chronic respiratory failure in stable condition. In our area there are controversies related to their "misuse" perhaps attributable to the lack of an updated regulatory framework and a national registration system, as was recommended by the Argentine consensus of OCD. It was performed a diagnosis of the current situation in Northwest Argentina (NOA)-AAMR Region to develop concrete future proposals. Material and Methods: A descriptive research was carried out in the NOA Region. The reference population was determined by the three sectors involved in the provision of OCD: pulmonologists in the region, the main suppliers of medical oxygen and the three health subsystems. Surveys and interviews especially designed were applied. Results: 65 pulmonologists of NOA responded (71% of the overall of specialists in NOA): 91% prescribed OCD, with an average of 11 patients per professional. Respiratory failure due to COPD was the most common indication of oxygen therapy. 54% believe that the equipment awarded to the patient does not conform to that prescribe. In one of the provinces, not pulmonologists physicians were authorized to prescribing OCD. Representatives of oxygen suppliers responded working under the ANMAT regulations and national legislation. Data of 52 Social Work and Private Medicine and also information of three system of state management were obtained. Health subsystems coverage is uneven and reported not having database. All agreed on the need to unify regulations and propose a single regulatory framework. Conclusion: The diagnosis of the situation on the prescription and delivery of oxygen therapy in the NOA notes the lack of a regulatory framework in Argentina that covers all aspects of OCD. Existing regulations are not sufficient for the proper use of the OCD and the implementations of the recommendations of the Argentine consensus were not expected. The working group developed proposals as updating the National OCD Consensus, the creation of a National Registration System and the construction of a "legal instrument" to support oxygen treatment, all measures aimed at a more equitable distribution of expenses Health.

Curvas de supervivencia y permanencia en el programa de oxigenoterapia domiciliaria y ventilación no invasiva (Bilevel/CPAP): Obra Social de Empleados Públicos de Mendoza, 1752 pacientes en el período 2004-2014 / Survival Curves and Continuation Time, Program of Homecare Oxygen Therapy and Noninvasive Ventilation (Bilevel/CPAP)

Introducción y objetivos: La oxigenoterapia es una terapéutica trascendente dentro de las enfermedades respiratorias, siendo la oxigenoterapia crónica domiciliaria (OCD) y la oxigenoterapia domiciliaria en otras situaciones (OT) costo-efectiva. Se realizó un estudio retrospectivo de 10 años con el objetivo de conocer y comparar el tiempo de permanencia y supervivencia (mediana en meses) dentro de un programa de oxigenoterapia y ventilación no invasiva, su relación con el tipo indicación (OCD, OT), motivo de prescripción (patología) y sexo. Resultados: Se estudiaron 1752 pacientes, la prevalencia anual para oxigenoterapia fue de 90.47/100.000/habitantes/año. Para OCD las patologías más frecuentes fueron EPOC y enfermedades pulmonares intersticiales (fibrosis), el tiempo de permanencia fue de 15 meses y supervivencia de 23 meses. Para OT la causa más frecuente de prescripción fue cáncer (pulmonar y no pulmonar), el tiempo de permanencia fue de 2 meses y supervivencia de 3 meses. En ambos casos no se observaron diferencias estadísticamente signifcativas en cuanto al tiempo de permanencia y supervivencia en relación con el sexo. La causa principal de prescripción de CPAP fue síndrome de apneas hipopneas obstructivas del sueño (SAHOS), observando una permanencia de 66 meses. Las principales causas de prescripción de equipos Bilevel fueron EPOC, SAHOS y enfermedades neuromusculares con una permanencia de 34 meses, cuando se agregaba oxigenoterapia la permanencia era de 46 meses. Conclusiones: Es fundamental conocer las características de los pacientes, tiempos de permanencia, supervivencia, motivos de discontinuación, patología para la prescripción y el equipo suministrado, datos necesarios para la toma de decisiones destinadas al paciente y a la gestión de programas de oxigenoterapia.

Introduction and objectives: Oxygen therapy is a significant therapy for respiratory disease. Both Continuous Home Oxygen Therapy (COT) and Home Oxygen Therapy in Other Situations (TO) are cost-effective. A 10-year retrospective study was conducted, aimed at learning about and comparing the continuation time and survival curves (median in months) within a Continuous Home Oxygen Therapy and Non-Invasive Ventilation Program and its relation with the therapy type (COT, TO), reason for the prescription (pathology) and gender. Results: 1752 patients were studied. The annual prevalence of Oxygen Therapy was 90.47/100.000/population/year. For COT the most frequent pathologies were COPD and Pulmonary Fibrosis. The continuation time was 15 months and survival time 23 months. For TO the most frequent prescription was for the treatment of cancer (pulmonary and non-pulmonary); the continuation time was 2 months and survival time 3 months. No significant statistical differences were registered regarding gender in either case, continuation and survival time. The main cause of a Continuous Positive Airway Pressure (CPAP) prescription was Obstructive Sleep Apnea / Hypopnea Syndrome (OSAHS) with a continuation time of 66 months. The main causes of the Bilevel prescription were COPD, obstructive sleep apnea-hypopnea syndrome and neuromuscular diseases, with a continuation time of 34 months. When Oxygen Therapy was added, the continuation time was 46 months. Conclusions: It is essential to know the characteristics of patients, continuation time, survival curves, reasons for dropping and the treatment and equipment prescribed for the pathology, because these data are needed for decision-making aimed at the patient and the oxygen management program.

Making the scale for the compliance of patients with chronic obstructive pulmonary disease during home oxygen therapy / 中国实用护理杂志

Objective To make the scale for the compliance of patients with chronic obstructive pulmonary disease (COPD) during home oxygen therapy.Methods By literature searching,semi-structured interview,expert consultation,as well as pre test,the tentative scale was formed at first.Then the investigation was conducted among 324 patients with COPD selected.Finally the scale was formed by testing the reliability and validity.Results The scale was made up of two dimensions with 16 items in total.It showed that Cronbach α coefficient was 0.984,split-half reliability was 0.976,and content validity index was 0.98.The exploratory factor analysis combined with AMOS 7.0 confirmatory factor analysis was used for construct validity of the home oxygen therapy compliance scale.Conclusions The self-management behavior scale for patients with COPD shows good reliability and validity,which can be used to evaluate the compliance during home oxygen therapy and provide reference tool for COPD patients' family intervention.

Recomendações para oxigenoterapia domiciliar prolongada em crianças e adolescentes / Recommendations for long-term home oxygen therapy in children and adolescents

OBJETIVO: Orientar pediatras, neonatologistas, pneumologistas, pneumologistas pediátricos e outros profissionais envolvidos na área sobre as principais indicações e as particularidades da oxigenoterapia domiciliar prolongada em crianças e adolescentes. FONTES DOS DADOS: Pesquisa bibliográfica na base de dados MEDLINE/PubMed (1990 a 2011). Adicionalmente, referências de estudos selecionados foram incluídas. Como para muitos dos aspectos não existem evidências científicas consistentes, algumas recomendações citadas foram feitas com base em experiência clínica. SÍNTESE DOS DADOS: Oxigenoterapia domiciliar prolongada tem sido uma prática crescente nos pacientes pediátricos e se encontra indicada em casos de displasia broncopulmonar, fibrose cística, bronquiolite obliterante, pneumopatias intersticiais, hipertensão pulmonar, etc. Ressaltam-se como benefícios: redução de internações, otimização do crescimento físico e do desenvolvimento neurológico, melhora da tolerância ao exercício e da qualidade do sono e prevenção da hipertensão pulmonar/. Os níveis de saturação de oxigênio indicativos para a oxigenoterapia diferem dos estabelecidos para adultos com doença pulmonar obstrutiva crônica e variam de acordo com a doença e faixa etária. Para a avaliação da saturação de oxigênio, utiliza-se a oximetria de pulso, sendo a gasometria arterial dispensável. Há três fontes de oxigênio disponíveis: cilindros gasosos, oxigênio líquido e concentradores de oxigênio. Os fluxos utilizados costumam ser menores, assim como o número de horas/dia necessários, quando comparados ao uso em adultos. Em algumas doenças há melhora, e a suspensão do oxigênio é possível. CONCLUSÕES: Oxigenoterapia domiciliar prolongada é uma terapêutica cada vez mais comum em pediatria e suas indicações são numerosas. Há particularidades relevantes quando comparada aos adultos em relação às indicações, modo de uso e monitorização.

OBJECTIVE: To advise pediatricians, neonatologists, pulmonologists, pediatric pulmonologists, and other professionals in the area on the main indications and characteristics of long-term home oxygen therapy in children and adolescents. DATA SOURCE: A literature search was carried out in the MEDLINE/PubMed database (1990 to 2011). Additionally, references from selected studies were included. As consistent scientific evidence does not exist for many aspects, some of the recommendations were based on clinical experience. DATA SYNTHESIS: Long-term home oxygen therapy has been a growing practice in pediatric patients and is indicated in bronchopulmonary dysplasia, cystic fibrosis, bronchiolitis obliterans, interstitial lung diseases, and pulmonary hypertension, among others. The benefits are: decrease in hospitalizations, optimization of physical growth and neurological development, improvement of exercise tolerance and quality of sleep, and prevention of pulmonary hypertension/cor pulmonale. The levels of oxygen saturation indicative for oxygen therapy differ from those established for adults with chronic obstructive pulmonary disease, and vary according to age and disease. Pulse oximetry is used to evaluate oxygen saturation; arterial blood gas is unnecessary. There are three available sources of oxygen: gas cylinders, liquid oxygen, and oxygen concentrators. The flows used are usually smaller, as are the number of hours/day needed when compared to the use in adults. Some diseases show improvement and oxygen therapy discontinuation is possible. CONCLUSIONS: Long-term home oxygen therapy is increasingly common in pediatrics and has many indications. There are relevant particularities when compared to its use in adults, regarding indications, directions for use, and monitoring.

Clinical Features of Patients on Home Oxygen Therapy Due to Chronic Respiratory Failure at One University Hospital

BACKGROUND/AIMS: Home oxygen therapy (HOT) costs a great deal every year and demand for the service is growing. In Korea, health insurance has covered HOT since November 1, 2006. The objective of this study was to evaluate clinical features of patients who used long-term HOT due to chronic respiratory failure and to determine the appropriateness of oxygen prescriptions. METHODS: Between November 2006 and April 2010, patients prescribed long-term HOT were enrolled in the study at a tertiary university referral hospital and their medical records and telephone survey information were evaluated. In total, 340 patients were evaluated retrospectively. RESULTS: Regarding the initial indications for HOT, their mean PaO2 was 49.8 mmHg and mean SpO2 was 82.2%. Underlying diseases included chronic obstructive pulmonary disease (COPD, 19.8%), lung cancer (12.6%), and interstitial lung disease (11.2%). The admission rate within 1 year was 53.4% and the average number of admissions was 1.64/patient. Other underlying diseases for which oxygen was prescribed, despite not meeting the insurance coverage criteria, were lung cancer (36.6%) and interstitial pneumonia (16.6%). CONCLUSIONS: Home oxygen prescriptions have increased since health insurance coverage was extended. However, cases of oxygen prescriptions frequently do not meet the coverage criteria. It is important to discuss extending the coverage criteria to other disease groups, such as interstitial lung disease and lung cancer, in terms of cost-effectiveness. Further, physicians prescribing oxygen therapy should be educated regarding the criteria.

Long-term Oxygen Therapy for Chronic Respiratory Insufficiency: the Situation in Korea after the Health Insurance Coverage: a Multi-center Korean Survey -Study for the Development and Dissemination of the COPD Guidelines, Clinical Research Center for Chro / 결핵및호흡기질환

BACKGROUND: From November 2006, The national health insurance system in the Republic of Korea began to cover prescribed long-term oxygen therapy (LTOT) in patients with chronic respiratory insufficiency. This study examined the current status of LTOT after national health insurance coverage. METHODS: Between November 1, 2006 and June 30, 2008, the medical records of patients who were prescribed LTOT by chest physicians were reviewed. The data was collected from 13 university hospitals. RESULTS: 197 patients (131 male and 66 female) were prescribed LTOT. The mean age was 64.3+/-13.0 years. The most common underlying disease was chronic obstructive pulmonary disease (n=103, 52.3%). Chest physicians prescribed LTOT using arterial blood gas analysis or a pulse oxymeter (74.6%), symptoms (14%), or a pulmonary function test (11.2%). The mean oxygen flow rate was 1.56+/-0.68 L/min at rest, 2.08+/-0.91 L/min during exercise or 1.51+/-0.75 L/min during sleep. Most patients (98.3%) used oxygen concentrators. Only 19% of patients used ambulatory oxygen supplies. The oxygen saturation before and after LTOT was 83.18+/-10.48% and 91.64+/-7.1%, respectively. After LTOT, dyspnea improved in 81.2% of patients. The mean duration of LTOT was 16.85+/-6.71 hours/day. The rental cost for the oxygen concentrator and related electricity charges were 48,414+/-15,618 won/month and 40,352+/-36,815 won/month, respectively. Approximately 75% of patients had a regular visit by the company. 5.8% of patients had personal pulse oxymetry. 54.9% of patients had their oxygen saturation checked on each visit hospital. 8% of patients were current smokers. The most common complaint with LTOT was the limitation of daily activity (53%). The most common complaint with oxygen concentrators was noise (41%). CONCLUSION: The patients showed good compliance with LTOT. However, only a few patients used an ambulatory oxygen device or had their oxygen saturation measured.

Clinical Characteristics and Adherence of Patients Who Were Prescribed Home Oxygen Therapy Due to Chronic Respiratory Failure in One University Hospital: Survey after National Health Insurance Coverage / 결핵및호흡기질환

BACKGROUND: Despite the benefits of home oxygen therapy in patients suffering chronic respiratory failure, previous reports in Korea revealed lower compliance to oxygen therapy and a shorter time for oxygen use than expected. However, these papers were published before oxygen therapy was covered by the national insurance system. Therefore, this study examined whether there were some changes in compliance, using time and other clinical features of home oxygen therapy after insurance coverage. METHODS: This study reviewed the medical records of patients prescribed home oxygen therapy in our hospital from November 1, 2006 to September 31, 2008. The patients were interviewed either in person or by telephone to obtain information related to oxygen therapy. RESULTS: During study period, a total 105 patients started home oxygen therapy. The mean age was 69 and 60 (57%) were male. The mean oxygen partial pressure in the arterial blood was 54.5 mmHg and oxygen saturation was 86.3%. Primary diseases that caused hypoxemia were COPD (n=64), lung cancer (n=14), Tb destroyed lung (n=12) and others. After oxygen therapy, more than 50% of patients experienced relief of their subjective dyspnea. The mean daily use of oxygen was 9.8+/-7.3 hours and oxygen was not used during activity outside of their home (mean time, 5.4+/-3.7 hours). Twenty four patients (36%) stopped using oxygen voluntarily 7+/-4.7 months after being prescribed oxygen and showed a less severe pulmonary and right heart function. The causes of stopping were subjective symptom relief (n=11), inconvenience (n=6) and others (7). CONCLUSION: The prescription of home oxygen has increased since national insurance started to cover home oxygen therapy. However, the mean time for using oxygen is still shorter than expected. During activity of outside their home, patients could not use oxygen due to the absence of portable oxygen. Overall, continuous education to change the misunderstandings about oxygen therapy, more economic support from national insurance and coverage for portable oxygen are needed to extend the oxygen use time and maintain oxygen usage.

The Risk of Deep Vein Thrombosis of the Lower Extremities in Patients with Chronic Respiratory Disorders, based on the Results of Ultrasonography Screening / The Japanese Journal of Rehabilitation Medicine

We screened patients with chronic respiratory disorders for deep vein thrombosis (DVT) of the lower extremities using ultrasonography. These patients require pulmonary rehabilitation because of their physical disabilities and the reduction in their activities of daily living (ADL). The average soleus vein diameter, which is the reported source of most DVTs, was 6.1±1.5 mm in the control group, 6.8±2.1 mm in the home oxygen therapy (HOT) patients, and 7.0±1.6 mm in the non-HOT patients. The soleus vein diameters in the HOT and non-HOT patients were significantly greater than in the control group (<i>p</i>=0.003). The prevalence of calf DVTs in the HOT patients was significantly higher than in the non-HOT patients (14.3 % vs. 2.0 %, <i>p</i>=0.027). Therefore, patients with chronic respiratory disorders are at greater risks of developing DVT. Furthermore, it appears that not only the deterioration in ADL but also the presence of respiratory disorders and a hypoxic state may influence the onset of DVT in HOT patients. Chronic respiratory disorder is thought to be one of the risk factors for DVT. Therefore, preventive measures, such as ultrasonographic screening examinations, daily living guidance, and physical therapy, are important for patients with chronic respiratory disorders.

A Case of Post-severe Pneumonia Successfully Treated with Seihaito, who Discontinued Home Oxygen Therapy / 日本東洋医学雑誌

We report the case of a 76-year old male patient who was able to discontinue home oxygen therapy (HOT) after developing severe pneumonia, for which he was hospitalized on February 17, 2004.We first administered antibiotics. Although blood inflammatory response markers became negative, his hypoxemia persisted, and HOT was introduced.We subsequently administered Seihaito, without changing his other oral medications. Hypoxemia and his general condition then improved remarkably. In the end, the patient was able to discontinue HOT. This case may demonstrate an ability of Seihaito to contribute to respiratory tract clearance, and inhibit inflammatory response in the alveoli.

Home oxygen therapy in patients with chronic obstructive pulmonary disease / 대한내과학회지

Hypoxemia is a common occurrence in patients with chronic obstructive pulmonary disease (COPD). The presence and severity of hypoxemia correlated with the severity of pulmonary impairment. In this review, I describe the mechanisms and effects of hypoxemia, the benefits of home oxygen therapy and indications for its therapy and oxygen delivery systems. Home oxygen therapy may improve the survival, decrease pulmonary arterial pressure and pulmonary vascular resistance. In addition to, home oxygen therapy improves exercise endurance, decreases resting oxygen cost of breathing, and improves neuropsychiatric performance and sleep quality. Because home oxygen therapy is costly therapy that confers various benefits, insurance reimbursements for its prescription is regulated in Korea. I address practical issues including documenting and reimbursement for home oxygen therapy and the processing home oxygen therapy that is necessary for the patients with COPD to receive oxygen.

Long-term Prognosis and Physiologic Status of Patients Requiring Ventilatory Support Secondary to Chest wall Disorders / 결핵및호흡기질환

BACKGROUND: Chest wall deformities such as kyphoscoliosis, thoracoplasty, and fibrothorax cause ventilatory insufficiency that can lead to chronic respiratory failure, with recurrent fatal acute respiratory failure(ARF). This study evaluated the frequency and outcome of ARF, the physiologic status, and the long-term prognosis of these patients. METHODS: Twenty-nine patients with chest wall disorders, who experienced the first requirement of ventilatory support from ARF were examined. The mortality and recurrence rate of ARF, the pulmonary functions with arterial blood gas analysis, the efficacy of home oxygen therapy, and the long-term survival rate were investigated. RESULTS: 1) The mortality of the first ARF was 24.1%. ARF recurred more than once in 72.7% of the remaining 22 patients, and overall rate of successful weaning was 73.2%. 2) Twenty-two patients who recovered from the first ARF showed a restrictive ventilatory impairment with a mean FVC and TLC of 37.2% and 62.4 % of predicted value, respectively, and a mean PaCO2 of 57mmHg. Among the parameters of pulmonaty functions. the FVC(p=0.01) and VC(p=0.02) showed a significant correlation with the PaCO2 level. 3) There were no significant differences between the patients treated with conservative medical treatment only and those with additional home oxygen therapy due to significant hypoxemia in the patients with recurrent ARF and the mortality. 4) The 1, 3, 5-year survival rates were 75%, 66%, and 57%, respectively, in the 20 patients who had recovered from the first ARF, excluding the two patients managed by non-invasive nocturnal ventilatory support. CONCLUSION: These results suggest that active ventilatory support should be provided to patients with ARF and chest wall disorders. However, considering recurrent ARF and weak effect of home oxygen therapy, non-invasive domiciliary ventilation is recommended in those patients with these conditions to achieve a better long-term prognosis.

Long-term oxygen therapy in patients with chronic respiratory failure in one university hospital / 결핵및호흡기질환

BACKGROUND: Although home oxygen therapy in hypoxemic patients with chronic lung disease has been increasing over the decade in Korea, the present state has not been known well. This study was done to know the situation of home oxygen therapy in a Korean university hospital. METHODS: Between January 1, 2000 and August 31, 2003, 86 patients prescribed home oxygen therapy by the pulmonary physicians of Asan Medical Center were investigated using their medical record and questionnaire. RESULTS: Patients (52 men, mean age of 61 years) with home oxygen therapy were increasing by every year. Underlying diseases were COPD (n=29), tuberculous destroyed lung (n=18), bronchiectasis (n=15), ILD (n=12), and others. Baseline FEV1/FVC, FVC, and FEV1 of patients were 58.4+/-25.2%, 54.5+/-17.1% of predicted, and 41.7+/-20.6% of pred. Mean oxygen flow was 1.5 L/min and mean duration per day was 14.5 hours. During therapy, mean PaO2 values have increased from 51.2 to 77.7 mm Hg and PaCO2 values have increased from 47.5 to 49.6 mm Hg. Only 16.5% of the subjects were monitored by visiting nurses or pulse oximeter. Three year survival rate was 56.6% and hypercapnic patients showed better prognosis. CONCLUSION: The patients with home oxygen therapy were increasing yearly and a part of them were monitored. The hypercapnea respiratory failure patients would have better prognosis.