Presentation Transcript

1. Oxygen for IPF

   Simon Johnson
2. What is oxygen for? Oxygen is needed to generate energy for all body functions Muscles walking, lifting, dressing etc. Brain consciousness, thinking Normally oxygen levels are stable no matter how much exercise you do Symptoms of low oxygen Breathlessness Fatigue Cyanosis Fluid retention
3. Oxygen uptake from the lungs
4. Exercise increases oxygen extraction from the blood comfortable ‘normal’ breathless faint cyanosed O2 muscles muscles
5. How is this related to IPF? IPF reduces transfer of O2 from the lungs to the blood Desaturationto <88% during 6 min walk predicts outcome independent of age, sex, smoking, lung function and CT scores Decreased overnight saturation associated with reduced daytime energy and social functioning A low O2 causes frightening symptoms
6. Who needs oxygen therapy? Not everyone with IPF Not everyone who gets breathless Those limited by low blood oxygen walking outside / gardening around the house at night all or most of the time
7. British Thoracic Society guidelines In the absence of suitable controlled studies…………….. …. patients with persistent resting hypoxaemiaand who are breathless should be considered for oxygen at home delivered by oxygen concentrator. …… may also benefit form ambulatory oxygen if they remain active outside the home. Patients who are not chronically hypoxic but who are breathless, mobile and exhibit desaturation on exercise (90%) should be considered for ambulatory oxygen if improvement in exercise capacity and/or less breathlessness can be demonstrated by formal ambulatory oxygen assessment. Intermittent supplemental oxygen for periods of 10–20 min may relieve breathlessness associated with hypoxaemia in patients with ILD who do not require oxygen concentrator or ambulatory oxygen. When prescribing oxygen, individually titrate oxygen therapy according to oxygen saturations measured during normal activity. Nocturnal hypoxaemia is common in patients with IPF and may be associated with daytime impairment of quality of life, but there is no evidence that supplemental oxygen is useful in this setting. Clinical trials are required ……………….
8. How can you tell who needs oxygen? Blood gas test gives information on O2 and CO2 usually done at rest doesn’t predict what happens on exertion Six minute walk test gives information on O2 and exercise capacity well validated and predicts prognosis time consuming and hard work Corridor walk test easy and predicts need for ambulatory O2
9. 100 95 90 SaO2 85 80 75 70 65 pre walk minimum Corridor walk test
10. 24 hour O2 saturation awake asleep 7am 7pm 7am O2 pulse
11. Patient diary
12. Summary data Only 20 minutes with saturation in ‘red zone’ Good values overnight Discuss need for ambulatory O2
13. Different types of O2 therapy Long term O2 >15 hours / day Overnight O2 Short burst Ambulatory
14. Longer lasting systems Conserving devices double duration of cylinder use Portable concentrators small, fewer features, usually 2l only
15. Issues with O2 therapy for IPF Most evidence for O2 therapycomes from COPD Gas exchange and O2 requirements are different Prescribing O2 in IPF is different Not always practical around the home ‘I don’t want to get addicted to it’ Feeling self conscious about using O2 in public
16. Conclusions Need for O2 is independent of lung function more likely in patients with advanced disease O2 best prescribed after assessment on exertion and at night O2 can improve social functioning Various systems are available according to need and lifestyle
17. Any questions?
18. Travel >95% : fine <92% : supplementary in-flight oxygen 92-95% : flight assessment 15 mins of 15% oxygen