Oxygen on the move : Reducing hypoxemia indaily life for patients with COPD

Patients with COPD on long-term oxygen therapy (LTOT) often experience fluctuations in oxygen demand during walking, daily activities, and rest. Conventional fixed-dose oxygen therapy fails to adequately meet these dynamic needs, leading to episodes of hypoxemia that may negatively impact dyspnea, exercise endurance, and overall quality of life. Automated oxygen titration systems, have the potential to optimize oxygen delivery by adjusting flow rates in real time based on oxygen saturation (SpO₂). This thesis consists of four studies evaluating the feasibility, efficacy and patient experience of reducing hypoxemia using automated oxygen titration in patients with COPD on LTOT across walking, activities of daily living (ADL), and in the home environment. Two randomized crossover trials, one randomized crossover feasibility trial and a qualitative interview study were conducted. Oxygen flow was adjusted to maintain SpO₂ between 90-94% and compared to usual fixed-dose oxygen. Automated titration significantly increased time spent within target saturation and reduced episodes of hypoxemia compared to usual oxygen dose. It required a wide flow range and continuous monitoring. The improvements in oxygenation were associated with increased walking distance, enhanced ADL performance, and reduced dyspnea. At home, improving SpO₂ proved feasible, with high patient acceptance and it seemed to positively affect self-reported health. Patients described more ease daily functioning and expressed optimism about the technology.