Obstructive Lung Diseases: Airways 5 |

Retrospective Study to Analyze Domiciliary Oxygen Usage in VA Patients FREE TO VIEW

Monali Patil; Mansi Nigam, MD; Asma Tariq; Amita Krishnan, MD; M. Jeffrey Mador, MD
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University at Buffalo, Buffalo, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):876A. doi:10.1016/j.chest.2016.08.976
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Domiciliary oxygen is the key therapeutic tool used in treatment of chronic hypoxia. The aim of our study is to analyze the pattern of domiciliary oxygen usage among VA patients, and the diagnostic work up done to establish the etiology for hypoxia.

METHODS: Retrospective chart review of patients aged 40 yrs or older who were prescribed oxygen therapy in the fiscal year 2012 through 2014. Diagnostic category was determined as listed on the prescription for home o2. At 3 month after initiation every patient was re-assessed for continuation of O2 therapy.

RESULTS: 496 patients were included of which 96.7 % were male with mean age 74.0 years. 459/496 (92%) of patient were started on oxygen based on O2 saturation less than 88%, 36/496(7.25%) based on nocturnal pulse oximetry, one patient for cluster headache. 336/496 (67%) patients were given o2 therapy for 18-24hr, 54/496 (10%) for exertion, 62/496 (12.5%) for nocturnal hypoxia and 45/496 (9%) for unclear duration. Majority of home o2 therapy was initiated in an outpatient setting (343/496 69.2%). 103 patients (20.7%) had their home oxygen discontinued at 3 months as they no longer needed it. Discontinuation rate at 3 months was significantly higher (33%) in patient started on oxygen as inpatients compared to those started as outpatients (15%) (p < 0.0001, Fishers exact test). In those patients in whom oxygen was continued at 3 months, 353/378(93.4%) had a diagnosis for hypoxia. Pulmonary diagnoses were primarily responsible for oxygen prescriptions 310/353 (82.0%). Obstructive lung disease was the most common diagnosis (228/353 64.58%) followed by sleep apnea with nocturnal hypoxia despite CPAP (45/353), ILD (16/353), malignancy (12/353) and miscellaneous (12/343). Of the patients with pulmonary diagnosis 215/310 (69.35%) had pulmonary function testing. Among patients with obstructive lung disease 167/228 (73.24%) had pulmonary function testing out of which 135/167 (80.83%) had evidence of obstruction on spirometry.

CONCLUSIONS: Home oxygen is commonly prescribed for non COPD causes of hypoxia (42.0%). Patients need short term reassessment at 3 months as a substantial number of patients will no longer require it. Patient who require oxygen therapy need a thorough diagnostic evaluation for the underlying etiology with at least pulmonary function testing particularly if the etiology is suspected to be pulmonary.

CLINICAL IMPLICATIONS: A significant number of patient do not need home oxygen at 3 month assessment after the initial prescribe and the number is significantly higher if home oxygen was initiated at the time of hospital discharge.

DISCLOSURE: The following authors have nothing to disclose: Monali Patil, Mansi Nigam, Asma Tariq, Amita Krishnan, M. Jeffrey Mador

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