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Outcomes about Patterns of Domestic Activity and Ambulatory Oxygen Usage in COPD

March 29, 2016 Category: COPD

walk tests

Patient Characteristics

Fifty-two patients were initially screened, and the study profile is shown in Figure 1. Forty-two patients completed all walk tests. Twelve patients withdrew after the initial walk tests. Thirty patients were randomized to the 8-week home study, during which 9 patients withdrew and 1 patient died. The main reasons why patients withdrew from the study include having an exacerbation and the weight and lack of esthetics of the cylinder. One patient withdrew because he believed there was no additional benefit in using the cylinder. Tables 1, 2 show the baseline characteristics of the patients who completed the study. There were no differences between those using oxygen and those using air cylinders except for vital capacity and inspiratory capacity [p < 0.05].

Field Walking Tests

Performance of the ISWT and the ESWT before and after intervention are presented in Tables 3, 4.
There was no significant improvement in any of the additional outcome measures employed with the ISWT and the ESWT at the end of the study period (p > 0.05).

Domestic Activity

Measures of mean domestic activity performed before and after intervention for all subjects in both groups are presented in Table 5. There was no statistical difference in domestic activity for either group comparing before or after intervention (p > 0.05). However, there appeared to be a trend for domestic activity to increase with cylinder oxygen during the intervention and decrease with cylinder air. However, this gradual increase was not significantly significant (p = 0.46). The percentage changes between before and after intervention for cylinder oxygen and air were 7.34% (SD, 53.97%) and — 8.38% (SD, 19.06%) respectively. This was not statistically significant (p = 0.45). Become healthier with Canadian Health&Care Mall‘s medications and assistance.

Health Status

Health Status

There were no significant differences between before and after intervention for either cylinder oxygen and air for the self-reported CRQ (p > 0.05). When comparing the postintervention scores between the oxygen and air groups, there was no statistical difference (p > 0.05). Data presented as median (IQR) scores are presented in Table 6. When looking at the MCID, there was a worsening in the dyspnea domain for the air group after intervention (mean change, 0.6). There were no significant changes in the SF-36.

Cylinder Usage and Time Outdoors

Time for cylinder usage and time spent outdoors are presented in Figures 2 and 3, respectively. Pearson product correlation showed a significant correlations between time spent away from home and cylinder usage for cylinder oxygen at week 6 only (r = 0.77, p < 0.05), and for air at week 1 (r = 0.70, p < 0.05) and week 8 (r = 0.80, p < 0.001). There was a gradual increase in the use of cylinder gas over the 8 weeks in the oxygen group but not in the air group.

When directly comparing the two groups, there was a significant group difference for mean duration of cylinder usage (p < 0.027). However the group X time interaction was not significant: there was no significant difference in cylinder usage between the two groups over time. Within-group comparisons identified a significant increase in mean duration (minutes per day) of cylinder use (p < 0.05) between weeks 1 vs 7 and 1 vs 8 and between weeks 2 vs 7 and 2 vs 8 for cylinder oxygen. There was no significant difference in mean cylinder usage over the 8 weeks for cylinder air (Fig 2). There was a larger mean total number of cylinders used for oxygen than air: 20.20 cylinders (SD, 13.73) and 10.72 cylinders (SD, 4.90), respectively, over the 8 weeks, which was statistically significant (p < 0.002).

When comparing the amount of time spent outside the home, there was no significant group X time interaction. There were no statistical differences within groups for time spent away from home (Fig 3).

Over the 8 weeks, the majority of patients were using the cylinder at home rather than outside (Table 7). However, for the oxygen group the number of times reported using the cylinder outside the home increased over the 8 weeks. This was not statistical significant (p > 0.05).

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Table 1—Patient Characteristics at Baseline

Characteristics Oxygen (n = 10) Air (n = 10)
Age, yr 70.7 (4.3) 76 (7.9)
Weight, kg 79.8 (18.0) 74.4 (15.3)
Body mass index, kg/m2 28.2 (5.4) 26.3 (5.5)
Male/female gender 6:4 8:2
FEV1, L 0.9 (0.9) 0.9 (0.7)
FEV1, % predicted 43.4 (16.0) 43.8 (28.5)
%cTp& 93.4 (2.3) 90.4 (5.3)
Oxygen therapy 5 none, 3 as needed, 2 LTOT 8 none, 1 as needed; 1 LTOT

Table 2—Patient Lung Function Data at Baseline

Parameters Oxygen (n = 10) Air (n = 10)
Vital capacity, L 3.1 (1.0); 93.3 2.2 (0.40); 68.4
Inspiratory capacity, L 2.2 (0.84); 87.4 1.4 (0.26); 62.4
Functional residual capacity, L 4.2 (1.2); 133.1 4.2 (1.2); 127.5
Expiratory reserve volume, L 0.9 (0.1); 109.4 1.2 (1.4); 97.3
Residual volume, L 3.3 (1.2); 141.7 3.8 (1.5); 133.9
Total lung capacity, L 6.4 (1.3); 107.8 5.7 (1.0); 106.0
Residual volume/total lung capacity, L 51.7(13.7); 123.7 53.0 (20.3); 136.1
Transfer capacity for carbon monoxide, SI 3.3 (1.3); 41.1 4.4 (2.0); 59.3
Alveolar volume, L 4.6 (1.1); 77.6 3.3 (1.5); 68.5
Kco, SI 0.7 (0.3); 55.9 1.5 (1.0); 85.2

Table 3—End-Exercise Heart Rate, Spo2, Borg Dyspnea, and Perceived Exertion

Variables Before Study After Study (8 wk)
Oxygen (n = 10) Air (n = 10) IOxygen Air
ISWT, m 243 (144.8) 224 (133.9) 251.1 (136.2) 211.1 (98.8)
Heart rate 105.1 (16.6) 108.3 (16.8) 108.1 (17.4) 100.4 (13.5)
cTpS 83.0 (6.6) 78.9 (10.7) 84.4 (6.2) 81.4(7.2)
Borg dyspnea 4.7 (1.5) 4.3 (1.2) 5.3 (1.7) 4.6 (1.6)
Perceived exertion 14.0(1.7) 13.9 (2.0) 14.8 (2.7) 14.2 (1.9)

Table 4—End-Exercise Heart Rate, Spo2, Borg Dyspnea, and Perceived Exertion

Variables Before Study After Study
Oxygen (n = 10) Air (n = 10) IOxygen Air
ESWT, s 298.3 (206.9) 190.2 (130.2) 340.0 (336.1) 170.3 (97.5)
Heart rate 115.8(11.1) 103.5 (17.3) 113.7 (11.1) 101.8(12.6)
%cTp& 81.1 (7.4) 80.3 (10.5) 83.3 (7.0) 82.0 (5.5)
Borg dyspnea 5.2 (1.6) 4.8 (1.3) 5.3 (1.3) 5.0 (1.9)
Perceived exertion 14.0(1.7) 13.9 (2.0) 15.2 (1.6) 15.0 (2.0)

Table 5—Domestic Activity Counts Before and After Intervention

Variables Oxygen Air
Before intervention 4,694.3(1,901.6) 6,429.6(5,001.8)
After intervention 6,912.1 (4,171.2) 5,999.6 (3,807.9)

Table 6—Preintervention and Postintervention CRQ Scores

Variables Before Intervention After Intervention
iOxygen (n = 10) Air (n = 10) iOxygen (n = 10) Air (n = 10)
Dyspnea 2.4 (2.1-2.8) 2.6 (2.3-4.2) 2.2 (1.8-3.0) 2.5 (1.5-3.2)
Emotion 4.9 (3.6-5.5) 4.1 (3.3-5.0) 4.8 (3.2-5.7) 3.8 (2.6-5.6)
Mastery 4.3 (3.8-5.9) 3.6 (2.9-5.3) 5.1 (3.2-5.9) 3.6 (2.3-5.0)
Fatigue 3.5 (2.5-4.6) 3.8 (1.7-4.3) 3.4 (2.8-4.8) 3.3 (1.8-4.3)

Table 7—Cylinder Use While Away From Home

Week Cylinder Oxygen Cylinder Air
IYes No Yes No
1 28 30 16 38
2 31 32 18 36
3 38 25 20 36
4 33 29 19 29
5 35 27 22 33
6 35 28 15 39
7 37 25 21 27
8 37 26 16 32

Figure 1. Flow of subjects.

Figure 1. Flow of subjects.

Figure 2. Cylinder duration (minutes per week).

Figure 2. Cylinder duration (minutes per week).

Figure 3. Time spent away from home (minutes per week).

Figure 3. Time spent away from home (minutes per week).

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