ABSTRACT
The British Thoracic Society (BTS) Home Oxygen Guideline provides detailed evidence-based guidance for the use of home oxygen for patients out of hospital. Although the majority of evidence comes from the use of oxygen in patients with chronic obstructive pulmonary disease, the scope of the guidance includes patients with a variety of long-term respiratory illnesses and other groups in whom oxygen is currently ordered, such as those with cardiac failure, cancer and end-stage cardiorespiratory disease, terminal illness or cluster headache. It explores the evidence base for the use of different modalities of oxygen therapy and patient-related outcomes such as mortality, symptoms and quality of life. The guideline also makes recommendations for assessment and follow-up protocols, and risk assessments, particularly in the clinically challenging area of home oxygen users who smoke. The guideline development group is aware of the potential for confusion sometimes caused by the current nomenclature for different types of home oxygen, and rather than renaming them, has adopted the approach of clarifying those definitions, and in particular emphasising what is meant by long-term oxygen therapy and palliative oxygen therapy. The home oxygen guideline provides expert consensus opinion in areas where clinical evidence is lacking, and seeks to deliver improved prescribing practice, leading to improved compliance and improved patient outcomes, with consequent increased value to the health service.
Subject(s)
Home Care Services , Oxygen Inhalation Therapy/standards , Pulmonary Disease, Chronic Obstructive/therapy , Pulmonary Medicine/organization & administration , Societies, Medical/standards , Adult , Blood Gas Analysis , Humans , Oxygen/blood , Oxygen Inhalation Therapy/instrumentation , Patient Compliance , Quality of Life , United KingdomABSTRACT
Chronic obstructive pulmonary disease (COPD) is a growing challenge for the NHS. New technologies, such as telehealth, offer opportunities for health and social care providers to look at innovative ways to manage the condition. Studies show telehealth services can reduce admissions and bed days, and boost patient satisfaction, but more research is needed to establish whether these technologies are safe, efficient and economical.
Subject(s)
Pulmonary Disease, Chronic Obstructive/nursing , Telemetry , Telenursing , Attitude of Health Personnel , Humans , Patient Acceptance of Health Care , Technology Assessment, Biomedical , United KingdomABSTRACT
BACKGROUND: There is increasing interest in the cardiovascular pathology independently associated with chronic obstructive pulmonary disease (COPD). We examined the influence of long-term oxygen therapy (LTOT) on heart rate (RR) and QT time-series in COPD. METHODS: Ten hypoxic stable COPD patients underwent Holter ECG monitoring for 24 h and physical activity/energy expenditure monitoring for 5 days before and after LTOT. Variability of RR and QT time-series was quantified using standard statistics and their structural (correlation/scaling) properties were assessed using multifractal analysis. Pre- and post-LTOT cardiac/activity parameters were compared to examine the influence of oxygen therapy and circadian variation. RESULTS: PaO(2) increased (P = 0.0004) whilst PaCO(2) was unchanged (P = 0.56) following LTOT. Activity/energy expenditure estimates were also unchanged following LTOT (P = 0.64-0.99), but RR variability was increased during the morning (P < 0.05) and night (P < 0.1, trend only). Multifractality of RR and QT time-series was not significantly changed following LTOT, although QT multifractality showed some time-dependent fluctuations. Trends in RR and QT time-series over 24-h were similar pre- and post-LTOT, indicating a generally normal circadian response. CONCLUSIONS: An increase in HRV following LTOT (but notably in the absence of altered activity levels) provides tentative evidence that LTOT has a direct effect on heart rate control in COPD. This beneficial influence was expressed mainly during the morning, and the relevance of this diurnal variation in response requires further investigation. It was also confirmed that both RR and (to a lesser degree) QT time-series in COPD have a multifractal structure, and this is not affected appreciably by LTOT.
Subject(s)
Heart Rate , Hypoxia/prevention & control , Hypoxia/physiopathology , Oxygen Inhalation Therapy/methods , Pulmonary Disease, Chronic Obstructive/prevention & control , Pulmonary Disease, Chronic Obstructive/physiopathology , Aged , Female , Humans , Hypoxia/complications , Longitudinal Studies , Male , Pulmonary Disease, Chronic Obstructive/complicationsABSTRACT
Joe Annandale describes how changing the respiratory nurse specialist role can improve outpatient waiting times and meet patients' needs.
