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Oxygen in Patients with Fibrotic Interstitial Lung Disease: An International Delphi Survey
Sabtu, 18 Mei 2019 09:53:42

Rachel K. LimChristopher J. HumphreysJulie MorissetAnne E. HollandKerri A. Johannson

European Respiratory Journal 2019; DOI: 10.1183/13993003.00421-2019

Abstract

Rationale Patients with fibrotic interstitial lung disease frequently develop resting or exertional hypoxemia. There is heterogeneity in clinical practice and a paucity of evidence guiding supplemental oxygen use in this patient population. The objectives of this study were to build international expert-based consensus on the indications and goals of supplemental oxygen from the perspective of health-care providers, and identify potential barriers to its access.

Methods Semi-structured interviews and a comprehensive literature search informed items for the Delphi survey, with items not meeting consensus included in the second round. The third round contained survey questions regarding regional funding coverage for oxygen therapy. A prioridefinitions of consensus were median scores of 4 (agree) to 5 (strongly agree) for “agreement”, 1 (strongly disagree) to 2 (disagree) for “disagreement”, or 3 (unsure) with an interquartile range of 0 to 1.

Results 42/45 (93%) experts completed all three survey rounds, representing 17 countries. 20/36 items met consensus for agreement or disagreement, ten items met consensus for unsure, and five items did not meet consensus. Experts agreed that oxygen should be recommended for patients with severe exertional hypoxemia, and in cases of exertional desaturation to <85–89%, particularly with attributable symptoms or exercise limitation. There are regional differences in funding coverage for oxygen, based on desaturation thresholds, clinical symptoms and testing requirements.

Conclusions Experts achieved consensus on 20 items guiding supplemental oxygen use in fibrotic interstitial lung disease. These data may inform research, clinical recommendations, and funding policy.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Dr. Lim has nothing to disclose.

Conflict of interest: Dr. Humphreys has nothing to disclose.

Conflict of interest: Dr. Morisset reports other from Hoffman La-Roche Ltd. , other from Boehringer-Ingelheim, outside the submitted work.

Conflict of interest: Dr. Holland reports non-financial support from Air Liquide, outside the submitted work.

Conflict of interest: Dr. Johannson reports grants from University of Calgary Division of Respiratory Medicine Fellowship Research Fund, during the conduct of the study; personal fees from Hoffman La Roche Ltd, personal fees from Boehringer Ingelheim, personal fees from Theravance, grants from UCB Biopharma SPRL, grants from Chest Foundation, grants from University of Calgary Cumming School of Medicine, outside the submitted work.