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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with great interest the paper recently published by Vieira et al&#46; in the <span class="elsevierStyleItalic">Portuguese Journal of Pulmonology</span> about the efficacy and patterns of ambulatory oxygen usage in a university hospital&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> To determine patterns of ambulatory oxygen &#40;AO&#41; use among patients with COPD and interstitial lung diseases&#44; the authors have studied 37 consecutive adult patients on AO by liquid O&#40;2&#41; for more than 3 months&#46; The acute response to O&#40;2&#41; was evaluated through the standardized 6-minute walk test &#40;6MWT&#41; and the Borg dyspnoea scale during a O&#40;2&#41; pre-intervention trial&#46; In relation to the acute response to O&#40;2&#41; there were significant improvements in the distance walked&#44; in resting SatO&#40;2&#41;&#44; in minimal SatO&#40;2&#41;&#44; and in percentage of desaturation&#44; independently of the diagnosis&#46; However&#44; acute improvement in 6MWT parameters was not predictive of enhancement of outdoor activities with AO&#46; AO was used for a mean of 4&#46;1<span class="elsevierStyleHsp" style=""></span>h&#47;day and surprisingly&#44; patients spent fewer hours per day away from home after AO treatment&#46; Moreover&#44; 16&#37; of the patients were not compliant to the prescription&#44; and 54&#37; mentioned side effects&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The ATS Guideline for the 6MWT<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> have established that the strongest indication for the 6MWT is for measuring the response to medical interventions in patients with moderate to severe heart or lung disease&#44; as a one-time measure of functional status of patients&#44; and as a predictor of morbidity and mortality&#46; The number of meters walked has been accepted as the main variable to be recorded in these situations&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The paper from Vieira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> highlights a number of important problems related to 6MWT that we would like to consider&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">First of all&#44; it is necessary to say that in this Guideline there is no reference to the role of the 6MWT in the AO prescription&#46; Second&#44; it is very important to take into account that the 6MWT is not as simple as it may seem&#46; Not every walk performed in a hospital in the presence of someone in a white coat is a walk test&#46; In order for the test to be a valid instrument of measurement&#44; it should strictly conform to official guidelines&#44; for reasons of external validity&#46; This means having a long&#44; quiet corridor&#44; some clearly visible objects to mark the ends of the distance to be covered&#44; adequate safety measures&#44; and a dedicated member of staff &#40;a nurse or doctor&#41; to supervise the tests&#46; It would also require all patients under consideration for portable oxygen therapy to actually undergo 3 walk tests &#40;4&#44; counting the practice walk&#41;&#58; a walk at baseline&#44; a walk to titrate oxygen flow&#44; and a walk to evaluate response &#8211; this last one preferably taking place on a different day from the first one&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In most cases&#44; however&#44; the only test likely to be performed is the walk to set flow&#46; Third&#44; if oxygen is to be prescribed for patients who are unable to take the walk test because of some contraindication &#40;e&#46;g&#46;&#44; angina&#41;&#44; the guidelines as they are written will not be followed&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> At present&#44; most patients are receiving AO without a prior 6MWT being performed&#46; On the contrary&#44; the public health authorities have established the 6MWT as a prerequisite for the prescription of portable oxygen therapy in an attempt to reduce the cost of domiciliary respiratory therapies&#46; Finally&#44; as the authors have shown&#44; acute improvement in 6MWT parameters was not predictive of enhancement of outdoor activities with AO&#46; So&#44; what can we do&#63;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We daily see many patients who live more comfortably and with less dyspnoea on AO&#46; We do not think probably that the 6MWT is the best tool to test the benefits of AO in our patients&#46; Would a simple walk be enough&#63; A 2-min walk test&#63; Should we guarantee the use of as much oxygen as the patient can take if a chronic respiratory insufficiency<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> is present&#63; The study by Vieira et al&#46; is of interest for those who prescribe AO in their practice and it underscores the need for further study to identify the type of patient who will truly benefit from such therapy&#46;</p></span>"
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Letter to the Editor
Ambulatory oxygen: Is the six-minute walk test the best option?
Oxigenoterapia de deambulação: será o teste de 6 minutos de marcha a melhor opção?
S. Diaz Lobato
Corresponding author
sdiazlobato@gmail.com

Corresponding author.
, S. Mayoralas Alises, J.L. García Gonzalez
Servicio de Neumología, Hospital Ramón y Cajal, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with great interest the paper recently published by Vieira et al&#46; in the <span class="elsevierStyleItalic">Portuguese Journal of Pulmonology</span> about the efficacy and patterns of ambulatory oxygen usage in a university hospital&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> To determine patterns of ambulatory oxygen &#40;AO&#41; use among patients with COPD and interstitial lung diseases&#44; the authors have studied 37 consecutive adult patients on AO by liquid O&#40;2&#41; for more than 3 months&#46; The acute response to O&#40;2&#41; was evaluated through the standardized 6-minute walk test &#40;6MWT&#41; and the Borg dyspnoea scale during a O&#40;2&#41; pre-intervention trial&#46; In relation to the acute response to O&#40;2&#41; there were significant improvements in the distance walked&#44; in resting SatO&#40;2&#41;&#44; in minimal SatO&#40;2&#41;&#44; and in percentage of desaturation&#44; independently of the diagnosis&#46; However&#44; acute improvement in 6MWT parameters was not predictive of enhancement of outdoor activities with AO&#46; AO was used for a mean of 4&#46;1<span class="elsevierStyleHsp" style=""></span>h&#47;day and surprisingly&#44; patients spent fewer hours per day away from home after AO treatment&#46; Moreover&#44; 16&#37; of the patients were not compliant to the prescription&#44; and 54&#37; mentioned side effects&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The ATS Guideline for the 6MWT<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> have established that the strongest indication for the 6MWT is for measuring the response to medical interventions in patients with moderate to severe heart or lung disease&#44; as a one-time measure of functional status of patients&#44; and as a predictor of morbidity and mortality&#46; The number of meters walked has been accepted as the main variable to be recorded in these situations&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The paper from Vieira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> highlights a number of important problems related to 6MWT that we would like to consider&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">First of all&#44; it is necessary to say that in this Guideline there is no reference to the role of the 6MWT in the AO prescription&#46; Second&#44; it is very important to take into account that the 6MWT is not as simple as it may seem&#46; Not every walk performed in a hospital in the presence of someone in a white coat is a walk test&#46; In order for the test to be a valid instrument of measurement&#44; it should strictly conform to official guidelines&#44; for reasons of external validity&#46; This means having a long&#44; quiet corridor&#44; some clearly visible objects to mark the ends of the distance to be covered&#44; adequate safety measures&#44; and a dedicated member of staff &#40;a nurse or doctor&#41; to supervise the tests&#46; It would also require all patients under consideration for portable oxygen therapy to actually undergo 3 walk tests &#40;4&#44; counting the practice walk&#41;&#58; a walk at baseline&#44; a walk to titrate oxygen flow&#44; and a walk to evaluate response &#8211; this last one preferably taking place on a different day from the first one&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In most cases&#44; however&#44; the only test likely to be performed is the walk to set flow&#46; Third&#44; if oxygen is to be prescribed for patients who are unable to take the walk test because of some contraindication &#40;e&#46;g&#46;&#44; angina&#41;&#44; the guidelines as they are written will not be followed&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> At present&#44; most patients are receiving AO without a prior 6MWT being performed&#46; On the contrary&#44; the public health authorities have established the 6MWT as a prerequisite for the prescription of portable oxygen therapy in an attempt to reduce the cost of domiciliary respiratory therapies&#46; Finally&#44; as the authors have shown&#44; acute improvement in 6MWT parameters was not predictive of enhancement of outdoor activities with AO&#46; So&#44; what can we do&#63;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We daily see many patients who live more comfortably and with less dyspnoea on AO&#46; We do not think probably that the 6MWT is the best tool to test the benefits of AO in our patients&#46; Would a simple walk be enough&#63; A 2-min walk test&#63; Should we guarantee the use of as much oxygen as the patient can take if a chronic respiratory insufficiency<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> is present&#63; The study by Vieira et al&#46; is of interest for those who prescribe AO in their practice and it underscores the need for further study to identify the type of patient who will truly benefit from such therapy&#46;</p></span>"
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Article information
ISSN: 08732159
Original language: English
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