Letter to the Editor
Response to the letter “Ambulatory oxygen: Is the 6 minute walk test the best option?”
Resposta à carta “Oxigenoterapia de deambulação: será o teste de 6 minutos de marcha a melhor opção?”
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"apellidos" => "Belchior" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Almeida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "V." "apellidos" => "Hespanhol" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:4 [ "nombre" => "J.C." "apellidos" => "Winck" "email" => array:1 [ 0 => "jwinck@hsjoao.min-saude.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Serviço de Imunoalergologia, Hospital de São João, EPE, Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Serviço de Pneumologia, Hospital de São João, EPE, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Serviço de Pneumologia, Hospital de São João, EPE, Porto/Faculdade de Medicina da Universidade do Porto, Porto, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Resposta à carta “Oxigenoterapia de deambulação: será o teste de 6 minutos de marcha a melhor opção?”" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We would like to thank the authors for their comment on our article<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> about the study on the prescription of ambulatory oxygen (AO) and for raising very pertinent and important issues.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our findings of relatively low adherence to prescribed AO are consistent with other studies, for example, a recent Italian survey<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> which confirmed that only 41% of the patients reported used liquid oxygen when outside the house.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In our study we clearly defined the criteria for use of AO; these consisted of exercise hypoxemia which is documented by a standardized 6-min walk test (6MWT) on air, evidence of significant desaturation (to 88% or less), the patient being responsive to oxygen, and significant daily activity. According to our data, positive response during the 6MWT did not help to predict greater use of the portable oxygen systems (POS). This led us to the conclusion, highlighted in the article, that non-adherence to AO may be closely related to the social stigma or the physical characteristics (like weight) of the POS.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The authors correctly discuss the role of the 6MWT in prescribing AO. In fact, although the ATS statement on the 6MWT<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> is not very clear in relation to prescribing AO, some authors have suggested the need for up to five 6MWT. To minimize the learning effect, the first two are training sessions, one of which may be performed with the patient carrying the weight of the oxygen source,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and then the oxygen titration should be performed after three 6MWT to evaluate the effect of breathing air and two different oxygen doses.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However, there is no standard titration method. According to the COPD ATS Guidelines it is recommended that the resting flow rate be increased by 1l/min during exercise.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> We opted to perform the walk test with the highest flow possible (6<span class="elsevierStyleHsp" style=""></span>L/min) because in some studies doubling the resting dose was not sufficient to prevent hypoxemia <a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and we wanted to make sure of providing adequate oxygenation during all activities. Moreover, we do not believe that in the real world the repetition of so many 6MWT is actually feasible and, in fact, 26% of respirologists around the world do not perform the oxygen titration test during exercise on every patient.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">It is important to note that the BTS recommendations published in 2006<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> suggest that “the initial assessment should be followed by a review after two months when the true value of AO can be judged by interview, diary card and oxygen usage”. In addition home follow-up within 4 weeks is strongly recommended. Without this monitoring patients might use systems or settings that do not maintain adequate oxygenation and as a consequence their physical activity is restricted and the health benefits lost. In our centre this strict protocol is not followed and so long-term compliance with AO can be affected.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We believe, therefore, that the acute assessment should be only one component of an AO evaluation. Objective compliance of oxygen use is urgently needed and newly designed Oxygen Therapy Monitoring Devices can improve the management of these patients.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">As we stated (because acute improvements in 6MWT parameters do not help predict outdoor activities) we need better tests to identify those who really respond to AO. As has been suggested by Vonbank et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> hemodynamic response to oxygen can be a better predictor. Others have implied that the more hyperinflated COPD patients are the ones that can benefit most<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> or we may even have to be more stringent in the criteria for AO prescription as suggested by Leach et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and only consider those who show 50% improvement in exercise ability!</p><p id="par0040" class="elsevierStylePara elsevierViewall">One thing is certain, although we have to increase the consensus around AO prescription, repeated educational sessions are definitely needed to improve compliance to long-term oxygen therapy.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and patterns of ambulatory oxygen usage – experience of a university hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. 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| 2017 November | 27 | 16 | 43 |
| 2017 October | 32 | 14 | 46 |
| 2017 September | 35 | 16 | 51 |
| 2017 August | 35 | 20 | 55 |
| 2017 July | 21 | 18 | 39 |
| 2017 June | 33 | 19 | 52 |
| 2017 May | 38 | 24 | 62 |
| 2017 April | 14 | 12 | 26 |
| 2017 March | 14 | 19 | 33 |
| 2017 February | 15 | 12 | 27 |
| 2017 January | 16 | 6 | 22 |
| 2016 December | 17 | 15 | 32 |
| 2016 November | 14 | 16 | 30 |
| 2016 October | 19 | 19 | 38 |
| 2016 September | 19 | 8 | 27 |
| 2016 August | 11 | 4 | 15 |
| 2016 July | 6 | 12 | 18 |
| 2016 June | 6 | 10 | 16 |
| 2016 May | 1 | 18 | 19 |
| 2016 April | 36 | 3 | 39 |
| 2016 March | 60 | 19 | 79 |
| 2016 February | 56 | 29 | 85 |
| 2016 January | 43 | 15 | 58 |
| 2015 December | 38 | 17 | 55 |
| 2015 November | 35 | 18 | 53 |
| 2015 October | 49 | 20 | 69 |
| 2015 September | 48 | 13 | 61 |
| 2015 August | 49 | 5 | 54 |
| 2015 July | 47 | 4 | 51 |
| 2015 June | 29 | 2 | 31 |
| 2015 May | 74 | 10 | 84 |
| 2015 April | 58 | 9 | 67 |
| 2015 March | 38 | 9 | 47 |
| 2015 February | 63 | 5 | 68 |
| 2015 January | 58 | 13 | 71 |
| 2014 December | 64 | 10 | 74 |
| 2014 November | 66 | 8 | 74 |
| 2014 October | 52 | 12 | 64 |
| 2014 September | 56 | 15 | 71 |
| 2014 August | 42 | 9 | 51 |
| 2014 July | 60 | 12 | 72 |
| 2014 June | 35 | 8 | 43 |
| 2014 May | 56 | 7 | 63 |
| 2014 April | 63 | 12 | 75 |
| 2014 March | 57 | 13 | 70 |
| 2014 February | 47 | 9 | 56 |
| 2014 January | 60 | 8 | 68 |
| 2013 December | 33 | 14 | 47 |
| 2013 November | 53 | 20 | 73 |
| 2013 October | 56 | 9 | 65 |
| 2013 September | 49 | 16 | 65 |
| 2013 August | 65 | 18 | 83 |
| 2013 July | 55 | 27 | 82 |
| 2013 June | 40 | 13 | 53 |
| 2013 May | 51 | 14 | 65 |
| 2013 April | 51 | 26 | 77 |
| 2013 March | 56 | 17 | 73 |
| 2013 February | 54 | 18 | 72 |
| 2013 January | 45 | 21 | 66 |
| 2012 December | 31 | 15 | 46 |
| 2012 November | 28 | 13 | 41 |
| 2012 October | 23 | 7 | 30 |
| 2012 September | 18 | 5 | 23 |
| 2012 January | 267 | 0 | 267 |
Show all
