Long Term Oxygen Therapy in Patients of COPD in Kashmir - Adherence and Barriers to Adherence

COPD is a growing global threat considering its increasing prevalence, morbidity and mortality. The only modality of treatment that has been proven to alter the late course of this disease is the long term oxygen therapy (LTOT). Considering that an increasing number of COPD patients are getting a prescription of LTOT, this study was done to recognize the common barriers that prevent its adequate compliance.METHODSA pre-set questionnaire was administered to patients and their caregivers regarding LTOT prescription, compliance to LTOT and reasons for their poor compliance to LTOT.RESULTS58 COPD patients included in the study completed the questionnaire. Only 12 (21.4%) patients used the recommended oxygen for more than 15 hours per day to give them the therapeutic benefit. 21 (37.5%) patients received recommended advice for the duration of using supplemental oxygen each day from their treating physicians. None of the patients received education about the correct use of using oxygen therapy at home.CONCLUSIONSOxygen usage among patients who have been prescribed home oxygen therapy is far from optimal, and both patient and physician related factors are responsible for it. Thus, the knowledge of major factors responsible for poor compliance of LTOT stresses upon the need for proper education of the treating physician and proper advice and counselling for this treatment modality at the time of prescription, for the patient.

RESPIRATORY SUPPORT FOR HOME CARE PATIENTS

Home respiratory support for patients in the home care setting can range from simple oxygen supplementation, non-invasive ventilation, to home ventilation support via a tracheostomy. A home care doctor may not be able to know everything about ventilator support, but he should be familiar with the medical care of patients requiring one, and know who to refer to should patients require ventilator adjustments or troubleshooting. The management of such patients is challenging outside the hospital setting and usually requires a multidisciplinary team effort from the doctors, nurses, medical social worker, respiratory therapists, vendor of the ventilator and, most importantly, dedicated and well-trained caregivers. This article will cover two other important topics that Family Physicians should know when managing patients who require home respiratory support: home oxygen therapy and tracheostomy care.

The role of general practitioners in home oxygen therapy

Recommendation of oxygen therapy must include clear indication and benefits of its use, appropriate prescription, vigilant monitoring and appropriate methods of delivery. Home oxygen therapy is expensive, inconvenient and cumbersome; it should be recommended only if benefits outweigh the disadvantages and adverse effects of oxygen. GPs play an important supportive and supervisory role in the use of long-term oxygen therapy (LTOT) to improve mortality of patients with chronic hypoxaemia. Prescription of short burst oxygen therapy (SBOT) for palliation of breathlessness is without clear evidence of its efficacy. GPs can prescribe SBOT when other secondary causes of breathlessness are excluded or treated, when breathlessness is not relieved by other treatments and if an improvement can be documented in patients.