Automated Oxygen Delivery in Home Setting for Patients with COPD on Long-Term Oxygen Therapy – A Randomized Crossover Feasibility Trial

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Rationale: Patients with COPD on long-term oxygen therapy (LTOT) have an unmet need for oxygen adjustments during sleep, rest, and activity, documented by continuous monitoring of oxygen saturation (SpO 2 ). While emerging technology enables automated adjustments, its feasibility in home settings remains uncertain. This randomized crossover trial evaluated the feasibility and preliminary effects of continuous automated oxygen titration at home. Methods: The intervention period involved four days of automated oxygen titration targeting a SpO 2 of 90– 94% using a Bluetooth-connected electronic device and wrist pulse oximeter, forming a closed-loop system. Oxygen flow (0.9– 6.8 L/min) was continuously adjusted based on SpO 2 . During the control period, patients received their usual fixed dose oxygen. Feasibility was defined as time with automated titration, time within target SpO 2 and patient acceptance. Additionally, health status was measured using the Clinical COPD Questionnaire (CCQ, minimal important difference 0.4). Results: Twelve patients (8 men, mean (SD) age 72.9 (5.5) years) on LTOT with an oxygen dose of 2.0 (0.8) L/min were included. Each patient provided more than 217,000 paired SpO 2 and oxygen flow data points. Oxygen flow was automatically adjusted for a median of 77 h (IQR 68.0– 84.3), covering 83% of the time. Time within target SpO 2 increased from 52% (42– 63) to 86% (75– 90) during the intervention. All patients used the full available flow range. The CCQ score improved by 0.74 (0.47) points; p < 0.001. Conclusion: Automated oxygen titration is feasible in the home setting, achieving more time with normoxia, but it required a wide flow range and continuous SpO2 monitoring. The patients reported a clinically relevant reductions in COPD symptoms measured with CCQ. The clinical importance of controlling SpO 2 needs to be examined in a larger study. Plain Language Summary: Why was the study done? Patients with COPD who use home oxygen often need different amounts during rest, activity, or sleep. Standard oxygen therapy provides a fixed amount, which may not meet these changing needs. This study tested whether oxygen could be adjusted automatically at home to better match each patient’s needs. What did the researchers do and find? Twelve patients on home oxygen used a new system that adjusted the oxygen flow automatically based on their blood oxygen levels. The system used a wrist-worn monitor and aimed to keep oxygen levels within a target range (90– 94%). The system worked well, automatically adjusting oxygen for the largest part of the time but using a wide range of oxygen flow. Time spent in the target range increased from 52% with usual therapy to 86% with the automated system. The patients reported improvements in both breathlessness and mental well-being. What do these results mean? Automatic oxygen adjustment at home is possible and helps patients spend more time with adequate oxygen levels. It needs continuous monitoring and flexible oxygen settings. This approach could improve comfort and quality of life for patients using home oxygen.