Università degli studi di Modena e Reggio Emilia

Long-term oxygen therapy (LTOT) at home is an established treatment, which is potentially subjected to inappropriate prescription. This retrospective study aims to identify the determinants of inappropriate prescription through the analysis of existing prescribing information for LTOT and routes of supply within the Northern area of the Emilia-Romagna Region. We selected all first time prescriptions for LTOT released in 2009 in the provinces of Modena, Parma, Piacenza and Reggio Emilia. A specific questionnaire with data collection through an electronic database allowed to analyze both organizational / administrative and clinical variables related to LTOT prescription. We analyzed a total of 364 prescriptions: 62 from Modena, 96 from Parma, 73 from Reggio Emilia, and 133 from Piacenza. The data collected highlighted several differences in the prescribing process between the four provinces. Among the most frequently omitted information in the prescription we identified: a) values of PaO2 and PaCO2 (absent in more than 90% of prescriptions dispensed at the AUSL Modena, while present in about 70% of prescriptions in Parma and in almost all of those of Piacenza and Reggio Emilia); b) differential information on oxygen flow at night or during exercise (absent in the prescriptions from Parma, Modena and Piacenza and present in more than 60% of prescriptions from Reggio Emilia); c) indications concerning the follow-up (not covered in the prescriptions from Modena and Parma). Finally, definition of the diagnosis that justifies the need for prescription of LTOT is often missing or incomplete. Therefore the results of the study have allowed the identification of some factors of inappropriateness both on the clinical side and on the management side. This analysis indicates the need for interventions aimed at improving and standardizing the process of LTOT prescription.

Introduction. Long-term follow-up of patients with idiopathic pulmonary fibrosis (IPF) is an important component of their clinical management. While oxygen saturation (SpO2) measurement is widely used in both routine practice and clinical trials, feasibility and clinical relevance of long-term SpO2 monitoring has not been studied yet. Methods. We designed a 1-year multicenter prospective study aimed at evaluating the long-term feasibility of home daily SpO2 monitoring and its clinical relevance by assessment of correlation with a symptoms and quality of life (QoL) questionnaire. Enrolled patients received a multi-parameter digital recorder (Sally® Personal Assistant, Medigas, Italy), allowing acquisition, transmission and online web-based storage of SpO2 measurements, together with the data of a short questionnaire on symptoms and QoL. SpO2 data were acquired three times a day, for at least one minute, in resting conditions, while answers to the questionnaire were provided once a day. All data were transmitted daily to a dedicated server through the telephone landline. Spearman’s rank correlation coefficient () was used to calculate the correlation between SpO2 values and the QoL scores. Results. Six months interim analysis was based on 21 IPF patients (15 males, mean age 75 years; 9 receiving long-term oxygen therapy): 17 of them (81%) provided valid data for a mean time (± SD) of 175 (±78) days). The majority (66%) of patients provided sufficient data for calculating the correlation coefficient. In most patients (86%) SpO2 values decreased while QoL score increased (i.e. QoL deteriorated): in 5 the correlation was statistically significant. Patients monitored for longer time were more likely to show a statistically significant correlation between these two parameters. Home SpO2 monitoring was accepted positively by all patients; the majority of them (63%) was able to self-perform all required tasks. Missing data accounted for 41% of all expected data and were mostly due to technical issues during the first weeks of study. Conclusions. Non-invasive home daily monitoring of oxygen saturation is feasible and well accepted in IPF patients. SpO2 seems to correlate with changes in symptoms and QoL scores, thus confirming the clinical relevance of this parameter.