OXYWILD – Automated versus fixed-dose oxygen therapy during walking in patients with fibrotic interstitial lung diseases: a randomised controlled crossover study

Fibrotic interstitial lung diseases (F-ILDs) are a group of severe, scarring lung diseases often leading to respiratory failure and a need for supplemental oxygen. The symptom burden is high, and patients frequently experience severe dyspnoea, especially during physical exertion. Automated oxygen titration is an emerging treatment modality that continuously adjusts oxygen delivery in response to the patient’s real-time needs. This approach may meet the fluctuating oxygen demands during activity, thus preventing recurrent desaturation episodes and exercise limitation in patients with F-ILD. To compare the effects of automated oxygen titration versus fixed-dose oxygen on dyspnoea during exertion in patients with F-ILD desaturating during walking. In this randomised, controlled, double-blind, crossover trial, participants performed two endurance shuttle walk tests with either fixed-dose or automated oxygen titration via the O2matic equipment, targeting an oxygen saturation of 90–94%. The primary endpoint was dyspnoea at the latest corresponding iso-time; secondary endpoints included walking duration and time spent within the target oxygen saturation range. A mixed-effects analysis was used to compare the two oxygen delivery strategies. In total, 29 participants were included. Participants reported significantly less dyspnoea on the Borg CR10 scale during the endurance shuttle walk test when using automated oxygen titration compared with fixed-dose oxygen (mean difference: -1.5 (95% CI: -2.2 to -0.9). Time spent within the target oxygen saturation range was 25.5% (95% CI: 16.5 to 34.6) longer with automated titration, and walking duration was significantly prolonged compared to fixed-dose oxygen with a mean difference of 91.4 s (95% CI: 12.0 to 179.8). Improving oxygenation by automated oxygen titration during a walking test significantly reduced dyspnoea compared to fixed-dose oxygen in F-ILD patients with exercise-induced hypoxemia. Tailoring oxygen delivery seems to provide clinical benefits and improves patient experience when prescribing ambulatory oxygen. Clinicians and researchers are encouraged to focus on a more individualized approach in practice and future studies. Registration number: NCT06465654, Date of registration: 27/05 -2024.