open access

Vol 77, No 4 (2009)
ORIGINAL PAPERS
Published online: 2009-06-26
Submitted: 2013-02-22
Get Citation

Effects of nurse home visits on compliance to long-term oxygen therapy. 14 months follow-up

Jacek Nasiłowski, Tadeusz Przybyłowski, Joanna Klimiuk, Artur Leśkow, Katarzyna Orska, Ryszarda Chazan
Pneumonol Alergol Pol 2009;77(4):363-370.

open access

Vol 77, No 4 (2009)
ORIGINAL PAPERS
Published online: 2009-06-26
Submitted: 2013-02-22

Abstract


Introduction: Long-term oxygen therapy (LTOT) is the only treatment that improves prognosis in patients with chronic respiratory failure in the course of chronic obstructive pulmonary disease (COPD). This effect depends on the duration of oxygen use during the day and night. The aim of this study was to evaluate the daily use of oxygen concentrator and to analyze factors that promote patient compliance.
Material and methods: The study enrolled patients seen at the Long-Term Oxygen Therapy Center of the Department of Internal Medicine, Pneumology and Allergology, Medical University of Warsaw, Poland. Qualification for LTOT was in accordance with the guidelines of the Polish Respiratory Society and the European Respiratory Society (ERS). All patients were instructed to use oxygen therapy for at least 15 hours a day using a stationary oxygen concentrator. The duration of oxygen concentrator use was evaluated on the basis of the concentrator counter reading performed by visiting nurses. The visits were run on the monthly basis.
Results: The study group involved 30 subjects (77% of COPD patients). The mean age was 67 ± 9 years, mean FEV1 was 46 ± 18% predicted, RV/TLC was 64 ± 16% and PaO2 was 50 ± 6 mm Hg. The mean duration of the daily oxygen therapy for the entire study group was 12.5 ± 4.6 hours. Eleven (37%) patients complied with the treatment during the follow-up period with the mean duration of daily oxygen therapy 17.4 ± 2.6 hours. The mean oxygen therapy use in the non-compliant group of patients averaged 9.6 ± 2.7 hours. We found that highest percentage of patients (48%) used oxygen for an appropriate period of time in the # first month of the treatment. The second month the number decreased to about 30% and remained at this level until the end of the follow-up period. The analysis of the COPD patients showed that in case of the compliant subjects the values of total lung capacity (TLC) (100 ± 19% predicted v. 152 ± 36% predicted, p = 0.001) and PaCO2 (38 ± 6 mm Hg v. 47 ± 8 mm Hg, p < 0.05) were significantly lower in comparison to the group of patients who used the oxygen therapy for less than 15 hours a day. Fourteen (47%) patients reported a considerable increase in electricity consumption and seven (23%) patients complained about the noise of the oxygen concentrator. The daily oxygen use of this group was significantly lower in comparison to the patients who were not annoyed with the sound of the concentrator (9.0 ± 3.7 h/24 h v. 13.5 ± 4.4 h/24 h, p = 0.02).
Conclusions: Our study show that the patients’ compliance was the highest during the first month of the treatment only, and that the monthly home visit did not influence the patients’ self-discipline to use LTOT properly. The use of an alternative source of oxygen, such as liquid oxygen, which would not generate any noise or electricity consumption, may positively influence the patient’s compliance.

Abstract


Introduction: Long-term oxygen therapy (LTOT) is the only treatment that improves prognosis in patients with chronic respiratory failure in the course of chronic obstructive pulmonary disease (COPD). This effect depends on the duration of oxygen use during the day and night. The aim of this study was to evaluate the daily use of oxygen concentrator and to analyze factors that promote patient compliance.
Material and methods: The study enrolled patients seen at the Long-Term Oxygen Therapy Center of the Department of Internal Medicine, Pneumology and Allergology, Medical University of Warsaw, Poland. Qualification for LTOT was in accordance with the guidelines of the Polish Respiratory Society and the European Respiratory Society (ERS). All patients were instructed to use oxygen therapy for at least 15 hours a day using a stationary oxygen concentrator. The duration of oxygen concentrator use was evaluated on the basis of the concentrator counter reading performed by visiting nurses. The visits were run on the monthly basis.
Results: The study group involved 30 subjects (77% of COPD patients). The mean age was 67 ± 9 years, mean FEV1 was 46 ± 18% predicted, RV/TLC was 64 ± 16% and PaO2 was 50 ± 6 mm Hg. The mean duration of the daily oxygen therapy for the entire study group was 12.5 ± 4.6 hours. Eleven (37%) patients complied with the treatment during the follow-up period with the mean duration of daily oxygen therapy 17.4 ± 2.6 hours. The mean oxygen therapy use in the non-compliant group of patients averaged 9.6 ± 2.7 hours. We found that highest percentage of patients (48%) used oxygen for an appropriate period of time in the # first month of the treatment. The second month the number decreased to about 30% and remained at this level until the end of the follow-up period. The analysis of the COPD patients showed that in case of the compliant subjects the values of total lung capacity (TLC) (100 ± 19% predicted v. 152 ± 36% predicted, p = 0.001) and PaCO2 (38 ± 6 mm Hg v. 47 ± 8 mm Hg, p < 0.05) were significantly lower in comparison to the group of patients who used the oxygen therapy for less than 15 hours a day. Fourteen (47%) patients reported a considerable increase in electricity consumption and seven (23%) patients complained about the noise of the oxygen concentrator. The daily oxygen use of this group was significantly lower in comparison to the patients who were not annoyed with the sound of the concentrator (9.0 ± 3.7 h/24 h v. 13.5 ± 4.4 h/24 h, p = 0.02).
Conclusions: Our study show that the patients’ compliance was the highest during the first month of the treatment only, and that the monthly home visit did not influence the patients’ self-discipline to use LTOT properly. The use of an alternative source of oxygen, such as liquid oxygen, which would not generate any noise or electricity consumption, may positively influence the patient’s compliance.
Get Citation

Keywords

respiratory failure; long-term oxygen therapy; compliance; home visits

About this article
Title

Effects of nurse home visits on compliance to long-term oxygen therapy. 14 months follow-up

Journal

Advances in Respiratory Medicine

Issue

Vol 77, No 4 (2009)

Pages

363-370

Published online

2009-06-26

Bibliographic record

Pneumonol Alergol Pol 2009;77(4):363-370.

Keywords

respiratory failure
long-term oxygen therapy
compliance
home visits

Authors

Jacek Nasiłowski
Tadeusz Przybyłowski
Joanna Klimiuk
Artur Leśkow
Katarzyna Orska
Ryszarda Chazan

References (24)
  1. Donne J. Medytacja XVII. In: Barańczak S. ed. Antologia angielskiej poezji metafizycznej XVII stulecia.Antologia angielskiej poezji metafizycznej XVII stulecia. PIW, Warszawa 1991: 54–55.
  2. Sullivan CE, Issa FG, Berthon-Jones M, et al. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981; 1(8225): 862–865.
  3. Meduri GU, Conoscenti CC, Menashe P, et al. Noninvasive face mask ventilation in patients with acute respiratory failure. Chest. 1989; 95(4): 865–870.
  4. Leger P, Bedicam JM, Cornette A, et al. Nasal intermittent positive pressure ventilation. Long-term follow-up in patients with severe chronic respiratory insufficiency. Chest. 1994; 105(1): 100–105.
  5. Doherty MJ, Greenstome MA. Survey of non-invasive ventilation (NPPV) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) in the UK. Thorax. 1998; 53: 863–866.
  6. Vanpee D, Delaunois L, Lheureux P, et al. Survey of non-invasive ventilation for acute exacerbation of chronic obstructive pulmonary disease patients in emergency departments in Belgium. Eur J Emerg Med. 2002; 9(3): 217–224.
  7. Vitacca M, Ambrosino N, Clini E, et al. Physiological response to pressure support ventilation delivered before and after extubation in patients not capable of totally spontaneous autonomous breathing. Am J Respir Crit Care Med. 2001; 164(4): 638–641.
  8. Girou E, Schortgen F, Delclaux C, et al. Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA. 2000; 284(18): 2361–2367.
  9. Plant PK, Owen JL, Parrott S, et al. Cost effectiveness of ward based non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease: economic analysis of randomised controlled trial. BMJ. 2003; 326(7396): 956.
  10. Keenan SP, Sinuff T, Cook DJ, et al. When is the addition of noninvasive positive pressure ventilation effective in acute exacerbations of COPD? A systemic review Ann Intern Med. 2003; 138: 861–870.
  11. Ram FSF, Picot J, Lightowler J, et al. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2004(3): CD004104.
  12. Vital FMR, Saconato H, Ladeira MT, et al. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary edema. Cochrane Database Syst Rev. 2008(3): CD005351.
  13. Hilbert G, Gruson D, Vargas F, et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med. 2001; 344(7): 481–487.
  14. Finlay G, Concannon D, McDonnell TJ. Treatment of respiratory failure due to kyphoscoliosis with nasal intermittent positive pressure ventilation (NIPPV). Ir J Med Sci. 1995; 164(1): 28–30.
  15. Pérez de Llano LA, Golpe R, Ortiz Piquer M, et al. Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome. Chest. 2005; 128(2): 587–594.
  16. Burns KE. A., Adhikari N.K.., Medea M.O. A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation. Can J Anaesth. 2007; 53: 305–315.
  17. Auriant I, Jallot A, Hervé P, et al. Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Am J Respir Crit Care Med. 2001; 164(7): 1231–1235.
  18. Pierzchała W, Barczyk A, Górecka D, et al. Zalecenia skiego Towarzystwa Chorób Płuc rozpoznawania i leczenia przewlekłej obturacyjnej choroby płuc (POChP). Pneumonol Alergol Pol. 2010; 78: 318–347.
  19. Nasiłowski J, Leszczyk M, Bura M, et al. Stosowanie nieinwazyjnej wentylacji w oddziałach pulmonologicznych w sce. Pneumonol Alergol Pol. 2010; 78(supl. 1): 43.
  20. Lloyd-Owen SJ, Donaldson GC, Ambrosino N, et al. Patterns of home mechanical ventilation use in Europe: results from the Eurovent survey. Eur Respir J. 2005; 25(6): 1025–1031.
  21. Escarrabill J. Organisation and delivery of home mechanical ventilation. Breathe. 2009; 6: 37–42.
  22. Nasiłowski J, Szkulmowski Z, Migdał M, et al. Rozpowszechnienie wspomagania wentylacji w warunkach domowych w sce. Pneumonol Alergol Pol. 2010; 78: 392–398.
  23. Rozporządzenie Ministra Zdrowia. www.mz.gov.pl (30.08.2009).
  24. Nasiłowski J, Zieliński J, Chazan R. Uneven use of noninvasive ventilation in acute respiratory failure in Europe. Eur Respir J. 2011; 37(6): 1536; author reply 1537.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Czasopismo Pneumonologia i Alergologia Polska dostęne jest również w Ikamed - księgarnia medyczna

Wydawcą serwisu jest "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl