Automated Oxygen Titration During Walking in Patients With Lung Fibrosis (OXYWILD)
- Conditions
- Fibrosis LungRespiratory Therapy
- Interventions
- Other: Fixed dose oxygen treatmentOther: Automated variable dose oxygen treatment
- Registration Number
- NCT06465654
- Lead Sponsor
- Janne Hastrup Jensen
- Brief Summary
Fibrotic lung disease is a group of severe scarring lung diseases with a dismal prognosis, often leading to respiratory failure and need for oxygen treatment. The symptom burden is often extremely high with dyspnea at rest and increasing dyspnea with exertion. Patients will often need more oxygen during activity thus repeatedly adjustments of oxygen flow rates are required to target an acceptable saturation at rest and during activities. This is impractical and can lead to an undesirable focus on oxygen levels as well as reduced use of the oxygen treatment in everyday life.
There is an urgent need for oxygen equipment that is easy to use to help patients live a life with fever symptom-related restrictions. Closed Loop Oxygen Titration (CLOT) is a new type of optimized oxygen treatment, which automatically adjusts the oxygen flow rate to the exact amount needed for the patient. The CLOT has already been tested and found useful in patients with other lung diseases, however it has not yet been tested in an isolated group of patients with fibrotic lung disease.
The goal of this clinical trial is therefore to study if automatically adjusted oxygen delivery can be useful for patients with fibrotic lung disease who needs oxygen treatment during activity.
The main questions aimed to be answered are: Will participants experience less breathlessness during walking, when the oxygen supply is individually adjusted to maintain an acceptable level of oxygen saturation?
Our hypotheses are that automatically adjusted oxygen dose during walking will results in less breathlessness compared to the usual fixed dose of oxygen. Furthermore, that participants will walk longer and maintain a better oxygen saturation during a walking test when offered automatically adjusted oxygen dose.
Participants will perform two walking tests with both automatically adjusted and fixed dose oxygen in random order, and the difference in sensation of breathlessness will be compared between the two tests.
- Detailed Description
Recruitment of participants
Participants with fibrotic lung disease will be recruited by a pulmonary specialist from the Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital during a routine outpatient visit. If exertional oxygen desaturation is suspected or has been documented by a six-minute walking test the investigator, a pulmonary specialist will inform the patient about the study and ask for study participation.
The patient will be asked to sign the informed consent. The information given to the patient specifies that the informed consent gives access for study personnel to access the medical record for relevant information necessary to complete the study. The written informed consent form will be signed and personally dated by the subject and the person conducting the informed consent conversation.
Ethical considerations
No risk for the patients is considered to be related to participation in the study. The walking tests are conducted by an experienced physiotherapist with solid knowledge about patients with fibrotic lung disease and when to terminate walking tests due to clinical symptoms. Furthermore, patients are enquired to stop the test if they experience discomfort. Walking tests with or without oxygen supply is a part of standard clinical practice for patients with fibrotic lung disease at the Centre of Rare Lung Diseases and the O2matic has been approved for clinical use.
Patients can benefit individually by gaining knowledge about their oxygen need at exercise, and as a group contribute to increased knowledge about the effect of automated oxygen treatment on dyspnea during exercise and on exercise endurance. International guidelines have restricted recommendations for ambulatory oxygen therapy due to limited evidence. This study may contribute to stronger recommendations for the prescription of ambulatory oxygen therapy in the future.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 28
- Verified diagnosis of fibrotic interstitial lung disease
- Desaturation during a recent (6 months) 6-minute walk test below 88% on atmospheric air or during an incremental shuttle walking test
- Able to walk at least 50 meters
- Self-reported stable respiratory symptoms in the previous 2 weeks
- Age ≥ 18 years
- Cognitively able to understand and participate in the study
- Written informed consent
- Long term oxygen treatment
- A pulmonary or cardiac condition other than fibrotic interstitial lung disease limiting exercise performance
- Unstable heart condition or symptomatic stenotic valve disease
- Any physical condition limiting exercise performance.
- Smoking the previous 24 hours
- Pregnancy
- Anaemia, haemoglobin < 7.3 mmol/l (women) or < 8.3 mmol/l (men)
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Arm && Interventions
Group Intervention Description Endurance shuttle walk test with fixed dose oxygen treatment Fixed dose oxygen treatment The participant will conduct an endurance shuttle walk test with a fixed oxygen dose of 4 liters/minute delivered by the O2matic. Endurance shuttle walk test with automated variable dose oxygen treatment Automated variable dose oxygen treatment The participant will conduct an endurance shuttle walk test with closed loop oxygen titration using O2matic to deliver a variable oxygen dosage set at an oxygen saturation target of 90 to 94 percent and an oxygen flow of 0 - 15 liters/minute.
- Primary Outcome Measures
Name Time Method Borg dyspnea score At baseline and through completion (one day) Primary outcome is the difference in Borg dyspnea score at isotime between the two endurance shuttle walk test (fixed dose oxygen compared to automated variable dose oxygen). The dyspnea score is rated every minute with the Borg Category-Ratio (CR)10 scale, where 0 is "no dyspnea at all" and 10 is "maximum dyspnea ever experienced".
- Secondary Outcome Measures
Name Time Method Hypoxemia At baseline and through completion (one day) Time to first moderate hypoxemia and severe hypoxemia
Walking distance At baseline and through completion (one day) Difference in walking distance in meters between groups in Endurance shuttle walking test
Walking time At baseline and through completion (one day) Difference in walking time in seconds between groups in Endurance shuttle walking test
Oxygen flow rate At baseline and through completion (one day) Difference in average oxygen flow rate (liter/minute) between groups in Endurance shuttle walking test.
Oxygen saturation levels At baseline and through completion (one day) Difference in time spent in seconds within acceptable oxygen saturation interval (oxygen saturation 90 - 94 percentage and time spent with moderate hypoxemia (oxygen saturation below 88 percentage) and severe hypoxemia (Oxygen saturation below 85 percentage) with moderate hypoxemia (oxygen saturation below 88 percentage) and severe hypoxemia (oxygen saturation below 85 percentage.
Difference in causes of walking limitations At baseline and through completion (one day) The participant is asked about factors limiting the walking distance.
Trial Locations
- Locations (1)
Aarhus University Hospital
🇩🇰Aarhus, Denmark