Ambulatory oxygen: why do COPD patients not use their portable systems as prescribed? A qualitative study

Abstract

BackgroundPatients with COPD on long term oxygen therapy frequently do not adhere to their prescription, and they frequently do not use their ambulatory oxygen systems as intended. Reasons for this lack of adherence are not known. The aim of this study was to obtain in-depth information about perceptions and use of prescribed ambulatory oxygen systems from patients with COPD to inform ambulatory oxygen design, prescription and management.MethodsA qualitative design was used, involving semi-structured face-to-face interviews informed by a grounded theory approach. Twenty-seven UK community-dwelling COPD patients using NHS prescribed ambulatory systems were recruited. Ambulatory oxygen systems comprised cylinders weighing 3.4 kg, a shoulder bag and nasal cannulae.ResultsParticipants reported that they: received no instruction on how to use ambulatory oxygen; were uncertain of the benefits; were afraid the system would run out while they were using it (due to lack of confidence in the cylinder gauge); were embarrassed at being seen with the system in public; and were unable to carry the system because of the cylinder weight. The essential role of carers was also highlighted, as participants with no immediate carers did not use ambulatory oxygen outside the house.ConclusionsThese participants highlighted previously unreported problems that prevented them from using ambulatory oxygen as prescribed. Our novel findings point to: concerns with the lack of specific information provision; the perceived unreliability of the oxygen system; important carer issues surrounding managing and using ambulatory oxygen equipment. All of these issues, as well as previously reported problems with system weight and patient embarrassment, should be addressed to improve adherence to ambulatory oxygen prescription and enhance the physical and social benefits of maintaining mobility in this patient group. Increased user involvement in both system development and service provision planning, could have avoided many of the difficulties highlighted by this study.

Evaluation of Adherence to Ambulatory Liquid Oxygen Treatment: Are Commercialized Dual-Pressure Transducers Helpful?

“…According to previous studies, a lack of information, fear that the oxygen might be depleted, embarrassment, and the weight of the ambulatory oxygen system are the main barriers to patient adherence. 2 The adequacy of ambulatory oxygen prescription in improving patients' quality of life has been discussed previously in studies using activity monitors, 18,19 but to our knowledge, patients' adherence to ambulatory LOX has never been evaluated using electronic monitoring.…”

“…1 It allows patients with severe respiratory diseases to remain active within the community and to maintain exercise tolerance and social interactions. 2 Recently, Criner 3 reviewed the end points for supplemental oxygen at home, such as mortality, effects on functional performance, sensation of dyspnea, cognitive function, and quality of life, and highlighted areas where future research is needed. With technological improvements, patients have more practical, simple, and smaller ambulatory oxygen systems, allowing for easier outdoor use.…”

“…4 In fact, Lacasse et al 5 had to prematurely end a trial investigating the use of ambulatory oxygen because the participants were not adherent, which is wasteful of health resources. 2 Determining the liquid oxygen (LOX) treatment compliance is important and enables the creation of mechanisms aimed at improving adherence or supporting the decision to suspend the treatment. This is particularly important at a time of financial austerity affecting health care services in Portugal as well as worldwide.…”

Domiciliary Oxygen: Facts and fallacies

“…It could be offered to patients with cystic fibrosis and active lifestyles or for some patients with interstitial lung disease (ILD) who do not qualify for LTOT and who desaturate during exercise and for patients with LTOT who can't leave the home without supplemental oxygen. For example, to go to a medical appointment [44]. Patients with neuromuscular diseases that compromise ventilation with HOS and OSA when using NOT should be associated with noninvasive ventilation (NIV) and only if NOD does not correct with the latter tool.…”

Respiratory Care Year in Review 2011: Long-Term Oxygen Therapy, Pulmonary Rehabilitation, Airway Management, Acute Lung Injury, Education, and Management

“…Arnold et al, 9 employing a grounded theory methodology, attempted to probe deeper into the reasons offered by 27 COPD patients when asked why they do not use their ambulatory oxygen (AO) equipment as prescribed and furnished under the United Kingdom National Health Service. In grounded theory, researchers analyze the responses of previously interviewed subjects to prepare more specific questions on a particular topic, which are in turn used in subsequent interviews of subjects with similar characteristics providing similar initial response.…”