Long-term oxygen therapy prescription in India: Evaluation of compliance, factors affecting compliance, indications, and survival

Abstract

Introduction: The international data shows that long-term oxygen therapy (LTOT) compliance is insufficient and variable. We conducted the first study from India on LTOT compliance, factors affecting compliance, indications, and survival through oxygen concentrator. Materials and Methods: Our organization from Delhi had given 378 oxygen concentrators over the last 5 years. We evaluated 120 patients randomly for participating in the study. Compliance was defined as the use of LTOT for at least 15 h/day. Results: Ninety-seven patients were included in the final analysis after exclusion criteria. The compliance to LTOT was seen in 45.36% (44/97). The commonest cause of noncompliance was lack of instructions (49.06%) followed by electricity issues, social stigma, and workplace constraints. A higher PaCO2 was associated with significantly lower compliance (PaCO2 53.18 vs. 44.98 mmHg, P = 0.036). Interstitial lung disease was associated with significantly higher compliance. Oxygen prescription was titrated with arterial blood gas analysis in only 4.12%. The indications for LTOT were chronic obstructive pulmonary disease (49.48%), posttuberculous obstructive airway disease (20.6%), and interstitial lung disease (12.37%). We found a significant reduction in the mean number of exacerbations/year from 3.91 to 1.93 (P < 0.0001). 61.86% of the patients were surviving on LTOT with a median survival time of 12 months. Conclusion: The adherence to LTOT in Indian patients is suboptimal mainly due to lack of instruction and is associated with a higher PaCO2. The practice of titration needs to be followed. The development of a national registry to monitor LTOT should be the long-term target.

Perception and Impact of Long-Term Oxygen Therapy on the Functioning and Quality of Life of Patients With Chronic Respiratory Disease: A Mixed-Method Study

“…The cultural stigma attached to visible signs of illness, combined with the physical encumbrance of LTOT, and lack of specific instructions regarding oxygen usage complicates patient adherence, echoing the dissonance noted by Arnold et al between health professional beliefs and patient realities [ 16 ]. The patients' faith and trust in physicians, associated with higher compliance [ 13 , 17 ], were similar to the findings of the present study.…”

“…This cultural hesitation is in contrast with Western settings, where there is a greater acceptance of medical technologies, influenced by a cultural trust in scientific progress and innovation. Bridging this cultural gap requires healthcare providers to integrate an understanding of these traditional beliefs with modern medical practices, potentially improving LTOT acceptance and adherence through a sensitive and informed approach to patient education that respects these cultural nuances [ 17 , 18 ].…”

“…This lack of support means that many patients are underinsured or uninsured, making the costs associated with oxygen therapy equipment daunting [ 33 ]. In addition, the financial pressures of managing a chronic illness can cause considerable psychological distress, negatively impacting the patient's QOL and well-being [ 17 , 33 ].…”

“…Furthermore, the constant visibility of their condition through the use of LTOT can exacerbate feelings of vulnerability and anxiety [ 17 ]. The psychological impact of such visibility cannot be understated, as it affects how patients view themselves and interact with the world.…”

Social dimensions of chronic respiratory disease: stigma, isolation, and loneliness

“…As part of efforts to hide their condition, people with chronic respiratory diseases have reported not using inhalers in public [19,26]. Similarly, in a survey of people with chronic lung disease prescribed long-term oxygen therapy, over half of participants (53/97) reported not adhering to the recommended daily usage, with the second most common reason (following lack of instruction, n ¼ 26) being social stigma (n ¼ 8) [27].…”