Long-Term Oxygen Therapy in COPD: Factors Affecting and Ways of Improving Patient Compliance

Table 1

Overview of adherence evaluation for LTOT.

Source	Subjects/methods	Adherence outcome percent or 𝑀 (SD)	Comments; future research needs
Evans et al. [25]	14 Concentrator patients Evaluated usage in comparison to prescribed 15 hours/day	𝑀=13.3 (2) h/d	Patient home respiratory support needed
Vergeret et al. [27]	159 Hypoxic COPD patients; Two randomly assigned groups to fixed unit only or fixed plus portable unit	Fixed: 𝑀=14 (3) h/d; Portable: 𝑀=17 (3.5) h/d	Oxygen use and quality of life increased with portable use. Equipment aesthetics and supervision during the first three months needed
Walshaw et al. [21]	61 patients reassessed for use and prescription appropriateness	45.9% inadequate prescription 29.5% compliance with correct prescription	Clinician and patient education should be enhanced
Howard et al. [20]	531 concentrators after use Compared prescription and concentrator clocks	Prescription <15 h/d then; Actual use 𝑀=9.9 h/d; Prescription >15 h/d then; Actual use 𝑀=13.4 h/d	LTOT is complex and education for rationale disease management needed. Regular home care is necessary
Restrick et al. [29]	176 patients interviewed and followed up	74% used 12 + h/d	Reassessment necessary. Greater communication among providers
Morrison and Stovall [10]	630 LTOT patients 79% were COPD; Database evaluation for three years	𝑀=14.9 h/d; 44% was less than 15 h/d	Instruction needed at time of prescription but also followup later when clinically stable
Pépin et al. [19]	930 COPD patients; Compared prescription and actual use	45% achieved 15 + h/d; Prescription 𝑀=16 h/d; Actual use 𝑀=14.5 h/d	Education at prescription needed and more prospective educational intervention studies necessary
Granados et al. [22]	62 LTOT patients participated 70% were COPD; Evaluated compliance and if hypoxemia was corrected	31% met all criteria for adherence to adequate prescription; 61% measured as compliant	Therapeutic process is noted as prescription, oxygen device, and compliance. Chronic care requires reassessment
Ringbæk et al. [28]	125 of 182 LTOT patients surveyed and evaluated as to activities and portable oxygen use	65% acceptable compliance; Ambulatory use positively affected compliance	Need to discuss how and when LTOT is used and portable oxygen options needed
Atiş et al. [30]	379 of 1100 patients responded to questionnaire	28.2% self-reported use was 15 + h/d 𝑀=9 h/d	Physician instruction and followup produced greater use by patients
Katsenos et al. [23]	249 LTOT patients; 75% were COPD patients	26.9% complied.; 55% did not receive precise written instructions concerning LTOT. 63% did not know LTOT importance for the management of COPD	A well-organized home care program may check LTOT utility and enhance its efficacy in COPD patients
Lacasse et al. [31]	24 hypoxic COPD patients were allocated to three interventions: oxygen concentrator only, concentrator plus as-needed ambulatory oxygen and concentrator plus ambulatory compressed air.; Comparison of home-based oxygen therapy alone with ambulatory oxygen added to home-based oxygen	Concentrator use: 18 h/day; Concentrator plus ambulatory oxygen: 17.4 h/day; Concentrator plus ambulatory compressed air: 18 h/day	The widespread provision of portable oxygen-dependent COPD patients is not justified. The efficient use of ambulatory oxygen in a successful course of respiratory rehabilitation remains to be determined
Nasiłowski et al. [32]	30 patients under LTOT (77% COPD patients) were followed up for14 consecutive months	37% compliance.; Higher compliance (48%) during the first month. Nurses’ frequent home visits did not increase compliance. Noise produced by concentrator influenced significantly the compliance	An alternative oxygen source, which would not generate any noise or electricity consumption may positively affect the compliance