To Örebro University

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.