Dr Rod Lawson

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Dr Rod Lawson

• Respiratory Consultant
• Sheffield Teaching Hospitals Foundation Trust

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Too much to do..
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Case 1

• 72 year old female
• Known severe COPD
• Unwell at home
• Visited by nurse
• Hypoxic, advised admission
• Delayed admission patient consent
• SHO record of conversation with daughter Not
  confused and able to talk untill oxygen put on by
  ambulance staff became unconcious
• On arrival at hospital, moribund

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Case 2

• 21 year old female
• Cystic fibrosis
• Lung transplant recommended declined
• Not for me
• What could help?
• I want to go clubbing with my friends
• Ambulatory oxygen went clubbing!

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Case 3

• 56 year old male
• COPD
• Car dealership, employed 14
• Sold business as unwell
• LTOT
• Bored wished to carry on work
• Second concentrator in office at work
• Still working

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Benefits of LTOT Provision

• Reduces hospital admission rates
• Reduces hospital inpatient bed days
• Reduction in hospital use greatest in those whose
  need is recognised as OP
• Risk factors for admission previous admission,
  low FEV1, underprescription of LTOT
• Reduces mortality

Ringbaek TJ, Viskum K, Lange P. Does long-term
oxygen therapy reduce hospitalisation in
hypoxaemic chronic obstructive pulmonary disease?
Department Of Respiratory Medicine, Hvidovre
Hospital, Denmark Garcia-Aymerich J, Monso E,
Marrades RM, Escarrabill J, Felez MA et al. Risk
factors for hospitalisation for a chronic
obstructive pulmonary disease exacerbation. EFRAM
study. NETT and MRC oxygen trials
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Benefits of LTOT (2)
Long-term home oxygen therapy improved survival
in a selected group of COPD patients with severe
hypoxaemia (arterial PaO2 less than 55 mm Hg (8.0
kPa)). Home oxygen therapy did not appear to
improve survival in patients with mild to
moderate hypoxaemia or in those with only
arterial desaturation at night. Cranston et
al Cochrane Database Systematic Reviews 2005 Oct
19(4)

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Benefits of LTOT (3)
 
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Saving Lives in COPD

• Stop smoking
• Possibly inhaled steroids/LABA
• Possibly pulmonary rehab
• Acute non-invasive ventilation
• LVRS

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Short Burst

• In conclusion, the availability of short-burst
  oxygen therapy for chronic obstructive pulmonary
  disease patients discharged from hospital
  following an acute exacerbation did not improve
  health-related quality of life or reduce acute
  healthcare utilisation. These results provide no
  support for the widespread use of short-burst
  oxygen therapy.
• Eaton et al
• Eur Resp J (2006) Apr27(4)697-704

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Why bother now?

• NSF committee large cross representation with
  NICE committee
• NSF committee large cross representation with
  oxygen guidleine committee
• Is it going to be different?
• Its good quality
• It saves lifes
• It advisory now, mandatory soon!!!!

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Stable COPD
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South Yorkshire Traffic Lights

• Bridge gap between reality and perfection
• Check list/benchmarking system
• Discussed at S. Yorks COPD interest group
• Multidisciplinary meeting

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Summary

• Good oxygen assessmentgood practice
• Saves admissions
• Saves lives
• Focus on LTOT
• It will be compulsory!!!