A nationwide structure for valid long-term oxygen therapy: 29-year prospective data in Sweden

Abstract

BackgroundLong-term oxygen therapy (LTOT) improves prognosis in COPD with severe hypoxemia. However, adherence to criteria for eligibility and quality of LTOT is often insufficient and varies between countries. The aim of this study was to evaluate a national structure for prescription and management of LTOT over three decades in Sweden.MethodsThe study was a prospective, population-based study of 23,909 patients on LTOT from 1987 to 2015 in the Swedish National Register of Respiratory Failure (Swedevox). We assessed the prevalence, incidence, and structure of LTOT; completeness of registration in Swedevox; and validity of prescription and management of LTOT in Sweden according to seven published quality indicators.ResultsLTOT was prescribed by 48 respiratory or medicine units and managed mainly by specialized oxygen nurses. Swedevox had a stable completeness of 85% of patients starting LTOT since 1987. The national incidence of LTOT increased from 3.9 to 14.7/100,000 inhabitants over the time period. In 2015, 2,596 patients had ongoing therapeutic LTOT in the registry, a national prevalence of 31.6/100,000. Adherence to prescription recommendations and fulfillment of quality criteria was stable or improved over time. Of patients starting LTOT in 2015, 88% had severe hypoxemia (partial pressure of arterial oxygen [PaO2] <7.4 kPa) and 97% had any degree of hypoxemia (PaO2 <8.0 kPa); 98% were prescribed oxygen ≥15 hours/day or more; 76% had both stationary and mobile oxygen equipment; 75% had a mean PaO2 >8.0 kPa breathing oxygen; and 98% were non-smokers.ConclusionWe present a structure for prescription, management, and follow-up of LTOT. The national registry effectively monitored adherence to prescription recommendations and most likely contributed to improved quality of care.

Safety of benzodiazepines and opioids in interstitial lung disease: a national prospective study

“…This was a nationwide, prospective, population-based study of patients with physician diagnosed oxygen-dependent fibrotic ILD in the Swedish National Registry of Respiratory Failure (Swedevox). [11] Swedevox covers approximately 85% of patients starting long-term oxygen therapy (LTOT) nationwide since 1987. [11]…”

“…[11] Swedevox covers approximately 85% of patients starting long-term oxygen therapy (LTOT) nationwide since 1987. [11]…”

Patient Experience in Home Respiratory Therapies: Where We Are and Where to Go

“…Table 1 summarizes 15 relevant studies on this topic. The majority of the studies ( n = 9) were conducted from 2009 onward and primarily assessed the prescription of HMV ( n = 10) [4,5,12,13,14,15,16,17,18,19], followed by LTOT ( n = 6) [19,20,21,22,23,24]. The estimated prevalence of HMV (from 2.5 to 23/100,000 population) and of LTOT (from 31.6 to 102/100,000 population) were variable among distinct regions or countries.…”

Oxygen therapy in COPD and interstitial lung disease: navigating the knowns and unknowns

“…The use of domiciliary oxygen therapy has been increasing worldwide in recent years, accounting for substantial health expenditure. The national incidence of domiciliary oxygen therapy in Sweden increased from 3.9 to 14.7 per 100 000 population between 1987 and 2015 [4]. In Australia, the total annual costs for domiciliary oxygen therapy were estimated to be AUD31 million in 2005, excluding indirect clinical costs associated with serial assessment, patient education and support [5].…”

“…More importantly, patients have described a range of physical difficulties and psychological burden with using domiciliary oxygen therapy [12][13][14]. Globally, chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) are the two most common indications for domiciliary oxygen therapy [4,[15][16][17]. Despite both diseases sharing clinical features of dyspnoea and exercise limitations, there are marked differences in their prevalence, pathophysiology and natural history.…”