SESSION TITLE: Obstructive Lung Disease Posters
SESSION TYPE: Original Investigation Posters
PRESENTED ON: October 18-21, 2020
PURPOSE: Clinical guidelines recommend long-term oxygen therapy (LTOT) in patients with COPD associated with chronic severe resting hypoxemia and short-term oxygen therapy (STOT) for severe resting hypoxemia at the time of hospital discharge following an exacerbation of COPD (AECOPD). Guidelines also recommend reassessing the need for home oxygen within 12-16 weeks of hospital discharge following an AECOPD to update the oxygen prescription as oxygen requirements evolve. Home oxygen can be discontinued in patients who no longer have severe, resting room air hypoxemia. (1) Evaluate how often patients with an AECOPD prescribed home oxygen (STOT or LTOT) undergo reassessment of the need for home oxygen 90 days after hospital discharge; and (2) Estimate the proportion of patients in whom home oxygen therapy can be discontinued within 90 days following a COPD exacerbation. A secondary objective is to describe the clinical characteristics of patients in whom home oxygen can be discontinued by 90 days.
METHODS: Retrospective cohort study using information recorded in electronic health records (EHR) of patients discharged on home oxygen therapy following an AECOPD during a 12-month period at a single minority-serving academic medical center.
RESULTS: Sixty-nine patients (n=22 STOT and n=47 LTOT patients; 62% black, 3% Hispanic) were discharged on home oxygen therapy following an AECOPD. Just over half (38/69, 55%) underwent reassessment of their need for home oxygen within 90 days of hospital discharge (64% [14/22] of STOT vs. 51% [24/47] of LTOT); 28/38 were appropriately reassessed at rest on room air. Most (25/28, 89%) of the patients reassessed at rest on room air did not meet criteria for LTOT and were therefore eligible for discontinuation (92% [11/12] of STOT vs. 88% [14/16] of LTOT patients). Patients who were eligible for discontinuation of home oxygen therapy were less likely to have comorbid obstructive sleep apnea, heart failure, and pneumonia compared to patients who were not eligible for discontinuation. Only 4 (16%) patients who were eligible for discontinuation of home oxygen therapy were discontinued at any point. Patients who were discontinued from home oxygen therapy were more likely to have been initiated on STOT and less likely to have obstructive sleep apnea compared to patients who were eligible for discontinuation but were not discontinued.
CONCLUSIONS: Only about half of patients discharged on home oxygen following an AECOPD undergo reassessment of their need to continue home oxygen. Home oxygen can be discontinued in most patients who are reassessed.
CLINICAL IMPLICATIONS: There is an impetus to re-examine oxygen prescribing practices for patients recovered from a severe AECOPD as a significant proportion will have no demonstrated long term benefit and are exposed to potential harms such as fires and the stigma associated with oxygen equipment.
DISCLOSURES: No relevant relationships by Yoo Jin Kim, source=Web Response
No relevant relationships by Jerry Krishnan, source=Web Response
No relevant relationships by Stephanie LaBedz, source=Web Response
No relevant relationships by Analisa Taylor, source=Web Response
© 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.