Oxygen therapy for patients with IPF
Vincent Cottin and Luca Richeldi discuss the importance of oxygen therapy for patients with IPF
VC: And what about oxygen therapy? Did you learn something about it?
LR: I learned that oxygen therapy is a big issue for the patients. Unfortunately, it doesn’t seem to be a big issue for clinical research. The way we prescribe oxygen is, I think, very subjective. We are basically prescribing oxygen based on very old British trials on COPD which seems a little bit strange. I know there are trials ongoing, on ambulatory oxygen, of course these are difficult trials to perform. But I think this is an area we need to explore more.
VC: Do you think there is room for randomized trials in the oxygen therapy?
LR: I think there should be room for randomized trials. In particular, Vincent, if you think of the fact that we have been exploring the efficacy of anti-oxidants. And oxygen is the king of oxidation, of oxidants. So you can make a point that probably the amount of oxygen that we give to our patients should be balanced in between what they need to get better oxygenation and to not oxidise too much, the environment in the lung. So, I think this is definitely in need for research, unfortunately, as you know, it’s difficult to find the funding to do the study.
VC: Ja, but also patients are advanced diseased when they are on oxygen, so you’re talking about doing research in patients with advanced disease. So it’s part of palliative care, basically.
LR: Which is also a challenge, always a challenge. I agree. I agree.
I’m just curious about which is your threshold to prescribe oxygen and is it a fixed threshold or it varies from patient to patient?
VC: So, for nocturnal supplemental oxygen I use the same threshold as in COPD patients. For ambulatory supplemental oxygen, like exercise, I do, first of all, I don’t prescribe it if there isn’t any strong decline in oxygen saturation during a 6 minute walk test. So, if there is an important decline and the patient is very short of breath and has some desire of improving the ability, then I propose it and I discuss with the patient also mentioning that the benefit would be on the symptoms, possibly also on the ability to exercise and have some more activity, but I’m also saying it’s not going to change the course of disease, right.
LR: It’s not a cure for IPF, just it’s supporting a better quality of life, maybe, that’s what we think.