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HOME OXYGEN THERAPY

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Basic situation and definition of home oxygen therapy

Clinically, it is common to see patients being hospitalized due to chronic respiratory diseases (such as chronic obstructive pulmonary disease, pulmonary heart disease) and, while their conditions can be stabilized post-treatment, they may still experience a low quality of life caused by chronic respiratory insufficiency, dyspnea, and cyanosis during movement. Patients who require long-term oxygen therapy opt to receive this care at home, to save costs and reduce the risk of nosocomial infections, and thus it is called home oxygen therapy.

Applicable groups

Home oxygen therapy is one of the most important means of treating hypoxemia outside the hospital. It is usually applied to the home treatment of bronchial asthma, chronic bronchitis, emphysema, angina pectoris, respiratory failure and heart failure.

Home oxygen therapy:

CLASSIFICATION

Classified according to home use scenarios Classified according to home oxygen supply devices Functions and effects

Long-term oxygen therapy(LTOT)

Patients with chronic hypoxemia, use ≥ 15 hours per day

Ambulatory oxygen therapy(AOT)

Used for supplemental oxygen during exercise or activity, for those who are not static oxygen deficient but dynamic oxygen deficient

Nocturnal oxygen therapy (NOT)

For those who do not perform oxygen therapy during daytime, but perform oxygen therapy at night

Transient paroxysmal oxygen therapy

Simple, intermittent oxygen therapy is needed to prevent hypoxemia in case of hypoxia

Palliative oxygen therapy (POT)

Oxygen therapy is employed to alleviate the respiratory distress and potential hypoxemia of patients afflicted with end-of-life illnesses.

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Oxygen cylinders

Available in different sizes such as 10L, 20L, 30L, etc., especially suitable for patients who need high flow rate and high oxygen demand

Molecular sieve oxygen concentrator

Through nitrogen and oxygen separation technology, molecular sieve adsorbs nitrogen and filters out harmful substances in the air to obtain purified oxygen that meets medical oxygen standards. The maximum pressure of oxygen production is 0.2~0.3MPa (i.e. 2~3kg), and there is no danger of high pressure and explosion. Currently the most stable and widely used, there are 3L, 5L, 8L, 10L and other different flow rate benchtop instruments.

Portable molecular sieve oxygen concentrators (POC) have developed rapidly in recent years, with specifications such as pulse dose 0.75L, 1L, 1.2L (correspondingly equivalent to 3L, 5L, 6L continuous oxygen delivery)

Liquid oxygen tank

Small and portable, suitable for oxygen supply on the go, oxygen supply time is 6~8 hours

Chemical oxygen production & other methods

Chemical oxygen production - the principle of using two chemical reagents to produce oxygen, the use of which is gradually decreasing
Portable oxygen chamber - the market for them having only just begun
Oxygen bag - temporary emergency use in the family

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Alleviate hypoxemia
When PaO₂ reaches above 60mmHg and SaO₂ reaches 85%-90%, it can meet the needs of tissue metabolism adequately.

Relieves pulmonary hypertension caused by hypoxia, reduces erythrocytosis, lowers blood viscosity, reduces the burden on the right ventricle, and delays the development of pulmonary heart disease

Oxygen can relieve bronchospasm, reduce respiratory distress and improve ventilation dysfunction

Improve the physical condition of patients, sleep and brain function, as well as exercise endurance and quality of life

Improve the prognosis and prolong the life of patients with chronic obstructive pulmonary disease

Reduce the number of hospitalizations and save medical costs

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Home oxygen therapy:

LONG TERM OXYGEN THERAPY

American Thoracic Society Official Clinical Practice Guidelines: Long-term home oxygen therapy is strongly recommended for patients with severe hypoxemia

Multicenter randomized clinical trial study: Mortality in the nocturnal oxygen therapy group of patients with hypoxic COPD was 1.94 times higher than in the continuous oxygen therapy group

Official Canadian evidence-based analysis: Severe hypoxemic COPD patients had a significantly lower mortality rate in the long-term oxygen therapy group than in the no long-term oxygen therapy group

  1. Susan S, et al. Home Oxygen Therapy for Adults with Chronic Lung Disease: An Official American Thoracic Society Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine Volume 202, Issue 10:e121-e141.
  2. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group. Ann Intern Med. 1980 Sep;93(3):391-8. doi: 10.7326/0003-4819-93-3-391. PMID: 6776858

Specially recommended for:

Chronic obstructive pulmonary disease (COPD) with severe hypoxemia

Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease characterized by persistent airflow limitation. According to the research results of Wang Chen, an academician of the Chinese Academy of Engineering and an expert in respiratory pathology and critical care medicine, published in the international authoritative medical journal The Lancet, there are more than 100 million COPD patients in China, making it the third most common chronic disease in China after hypertension and diabetes!

According to the American Thoracic Society Official Clinical Practice Guidelines, the evidence and its quality of "Long-term oxygen therapy is recommended for COPD patients with severe hypoxemia" are described as follows:

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Reduced risk of death

The NOTT study of 203 subjects showed a 55% reduction in the 2-year risk of death in the trial group prescribed 24-hour/day oxygen therapy compared with the control group prescribed only nighttime oxygen (relative risk [RR], 0.45; 95% confidence interval [C], 0.25-0.81)

 

MRC study of 87 subjects showed a 59% reduction in the 5-year risk of death in LTOT patients compared with no oxygen use

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Reduction in hospital days

A retrospective study found that subjects using LTOT had fewer hospitalizations over 3 years compared to conventional treatments (mean difference [MD], -1.17; 95% CI, -1.73 to -0.59)

 

An observational study found that among patients receiving LTOT, the number of days (years/patient) that patients were hospitalized at follow-up, decreased by 35%(RR , 0.65 ; 95%CI r 0.40-1.05)

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Pharmacoeconomic advantages

In the United States, for COPD patients with severe hypoxemia, the incremental cost-effectiveness ratio of long-term oxygen therapy was: USD16,124 for each additional unit of quality-adjusted life year (QALY), which is considered to be within the acceptable threshold

 

Thus, LTOT is considered a cost-effective prescription with pharmacoeconomic advantages 

  1. Susan S, et al. Home Oxygen Therapy for Adults with Chronic Lung Disease: An Official American Thoracic Society Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine Volume 202, Issue 10:e121-e141.

  2. Oba Y. Cost-effectiveness of long-term oxygen therapy for chronic obstructive disease. Am J Manag Care. 2009 Feb;15(2):97-104. PMID: 19284806.

Home oxygen therapy program for patients with chronic obstructive pulmonary disease:

Use of oxygen concentrators

CR-F5SW

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Use of ventilators with oxygen concentrators

Q25STW/Q20AW

CR-H Series

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A prospective observational study conducted in Barcelona showed an increase in mean oxygen saturation (91% vs. 88%; p = 0.0005) and a decrease in the cumulative time to oxygen saturation below 90% (CT90) in the group treated with a non-invasive ventilation device in combination with oxygen therapy.

Cuerpo S, Palomo M, Hernández-González F, Francesqui J, Albacar N, Hernández C, Blanco I, Embid C, Sellares J. Improving home oxygen therapy in patients with interstitial lung diseases: application of a noninvasive ventilation device. Ther Adv Respir Dis. 2020 Jan-Dec;14:1753466620963027

Specially recommended for:

Interstitial lung disease (ILD) with severe hypoxemia

Painful course of ILD

Severe hypoxemia is very common in people with interstitial lung disease (ILD).
Patients with idiopathic pulmonary fibrosis (IPF) often experience a progressive course characterized by dyspnea, cough, hypoxemia, episodes of acute respiratory deterioration, and premature death.
When with IPF, severe hypoxemia is often disabling and distressingly difficult to breathe.

Oxygen therapy is the only treatment

Apart from lung transplantation, assisted oxygenation is the only treatment that can improve hypoxemia, which persists despite optimal pharmacological treatment of the underlying disease.

LTOT is beneficial to patients

The American Thoracic Society Official Clinical Practice Guidelines panel judged that the benefits of LTOT for severe hypoxemia are substantial for most adults with ILD. As previously mentioned, LTOT for severe hypoxemia may result in reduced mortality in patients with COPD and may also prevent organ dysfunction due to severe persistent hypoxemia, including prevention of PH. Other benefits include relief of dyspnea and improvement in disability and health-related quality of life (HRQL).

  1. Susan S, et al. Home Oxygen Therapy for Adults with Chronic Lung Disease: An Official American Thoracic Society Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine Volume 202, Issue 10:e121-e141.

Home oxygen therapy:

CARER SOLUTION

CARER Home Oxygen Therapy in Clinical Practice

CARER Respiratory Solutions: The most extensive in China

Medical Oxygen Concentrator + Portable Pulse Oxygen Concentrator + Continuous Positive Airway Pressure/Dual Level Ventilator + High Flow Humidification + Nebulizer + Sputum Aspirator

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Adult Obstructive Sleep Apnea Primary Care Guidelines 

OSA

Continuous Positive Airway Pressure

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Q20AW

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American Thoracic Society Official Clinical Practice Guidelines

CR-H Series

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LTOT / ILD

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Portable Oxygen Concentrator

COPD

Bilevel Ventilator

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Q25STW

Please stay tuned

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