To Örebro University

The need for oxygen increases with activity in patients with COPD and on long-term oxygen treatment (LTOT), leading to periods of hypoxemia, which may influence the patient's performance. This study aimed to evaluate the effect of automated oxygen titration compared to usual fixed-dose oxygen treatment during walking on dyspnea and endurance in patients with COPD and on LTOT. In a double-blinded randomised crossover trial, 33 patients were assigned to use either automated oxygen titration or the usual fixed-dose in a random order in two walking tests. A closed-loop device, O2matic delivered a variable oxygen dose set with a target saturation of 90-94%. The patients had a home oxygen flow of (mean ± SD) 1.6 ± 0.9 L/min. At the last corresponding isotime in the endurance shuttle walk test, the patients reported dyspnea equal to median (IQR) 4 (3-6) when using automated oxygen titration and 8 (5-9) when using fixed doses, p < 0.001. The patients walked 10.9 (6.5-14.9) min with automated oxygen compared to 5.5 (3.3-7.9) min with fixed-dose, p < 0.001. Walking with automated oxygen titration had a statistically significant and clinically important effect on dyspnea. Furthermore, the patients walked for a 98% longer time when hypoxemia was reduced with a more well-matched, personalised oxygen treatment.

BACKGROUND: Minimising hypoxaemia during submaximal walking tests has a positive effect on exercise capacity and dyspnoea in patients with chronic obstructive pulmonary disease (COPD) on long-term oxygen therapy (LTOT). However, the impact of optimising oxygenation during everyday tasks remains unexplored. Therefore, we investigated the effects of maintaining a target saturation on activities of daily living (ADL) using automated oxygen titration compared with conventional fixed oxygen flow.

METHODS: In a double-blinded, randomised crossover trial, patients with COPD on LTOT performed two GlittreADL tests to assess the functional capacity of everyday activities using (1) their fixed oxygen dose and (2) an adjusted flow from 0 to 8 L/min targeting a peripheral oxygen saturation (SpO2) of 90-94%. A closed-loop device automatically titrated the oxygen based on information from a Bluetooth wrist pulse oximeter.

RESULTS: 31 patients (mean±SD age: 72.8±5.9 years, forced expiratory volume in 1 s of % predicted: 36.7±12.7) were included. The patients reduced the time to perform the ADL test by median (IQR) 38 (12-73) s, p<0.001, using automated titration compared with the fixed oxygen flow. The oxygen flow in the automated arm more than tripled to 5.4 (4.1-6.8) versus 1.6 (1.1-2.1) L/min (fixed) during the test, p<0.001, while the time spent within SpO2-target was increased from 19% to 49%, p=0.002. Correspondingly, the patients experienced less dyspnoea (BorgCR10); 5 (3-7) versus 6 (4-8), p<0.001, in favour of the automated oxygen titration.

CONCLUSIONS: Improving oxygenation and extending the time spent within target saturation reduced dyspnoea and improved functional capacity in ADL in patients with COPD on LTOT.

TRIAL REGISTRATION NUMBER: NCT05553847.

Rationale Patients with COPD on long-term oxygen therapy (LTOT) have an unmet need for oxygen adjustments during sleep, rest, and activity, documented by continuous monitoring of oxygen saturation. While emerging technology enables automated adjustments, its feasibility in home settings remains uncertain. This randomized crossover trial evaluated the feasibility and preliminary effects of continuous automated oxygen titration in the homes of patients on LTOT.

Methods The intervention involved four days of automated oxygen titration targeting a SpO₂ of 90-94% using a Bluetooth-connected electronic device and wrist pulse oximeter, forming a closed-loop system. Oxygen flow (0.9-6.8 L/min) was continuously adjusted based on SpO₂. During the control period, patients received their usual fixed dose oxygen. Feasibility was defined as successful automated titration time and time spent with normoxia. Changes in health status were measured using the Clinical COPD Questionnaire (CCQ).

Results Twelve patients on LTOT (2.0±0.8 L/min) were included, with more than 217,000 paired SpO2 and oxygen flow data points collected per patient. Oxygen flow was automatically adjusted for a median (IQR) of 77 (68.0–84.3) hours, covering 83% of the time. Time within target saturation increased significantly from 52% (42–63) to 86% (75–90) during intervention, with all patients utilizing the full available flow range. The CCQ score improved by 0.74±0.47 points, p <0.001.

Conclusion Automated home oxygen titration is feasible, achieving more time with normoxia, but it required a wide flow range and continuous monitoring. The patients reported notable reductions in COPD symptoms.

The present study included the first patients with COPD on long-term oxygen therapy who experienced second-by-second oxygen adjustments in their homes based on oxygen saturation. A device capable of automatically titrating the patient's oxygen was installed in the patients' home aiming at increasing the time spent within target saturation. We explored patients' experiences with this automated home oxygen titration, focusing on how maintaining target saturation affected daily life. Semi-structured interviews were conducted with eight men and four women after installation. Systematic text condensation was used in the analysis. Three main themes emerged from patient narratives: (1) "This is my life" - Patients preferred maintaining stable oxygen saturation, associating hypoxemia with dyspnea, discomfort, and difficulties with daily tasks. (2) "Getting the oxygen, I need" - Many patients reported improved ability to perform daily activities when oxygen was automatically adjusted. (3) "New technology gives hope for my life" - Patients expressed optimism about the potential of home-based technology, offering suggestions to improve usability, mainly by reducing concentrator noise. Our findings suggested high acceptability of the automated oxygen in the patients' home, as they believed it to increase the time spend with sufficient oxygen, especially during daily activities. Integrating patient insights is essential for implementation and acceptance of automated home oxygen therapy.