Serious Health Issues or Complication

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ASSESSMENT 3 2019 TEMPLATE
Please follow this template and use this question to conduct research.
Why is the oxygen therapy the best practice for patient with COPD despite the disbelief that it can
create serious health issues in them?
NSG2NMR (2019) Assessment 3: 2,000 individual report
Student First Name:
Student Surname:
Student ID Number:
Facilitator Name:
Site/Clinical School:
TOTAL Word Count: 2,000 +/- 10%
Excludes: reference list, appended search history
Includes: in-text citations
DUE DATE:
Identify a clinical issue and propose a research question about this clinical issue (approx. word
count 100)
There has always been the disbelief that oxygen therapy could have very serious health issues or
complication among the patients with COPD in the clinical context. Often, there has been various
attempts to determine the authenticity of this belief regarding the patients’ state of health overtime
as they are subjected to the therapy. It has sometimes affected the treatment regimen of the patients
who have ever heard about this belief or the owners of the patients who have ever had this belief
especially when they try resisting from being administered to the therapy. Despite the disbelief, the
therapy has continuously gained popularity and a broader application.
Research question: Why is oxygen therapy the best practice for patient with COPD despite the
disbelief that it can create serious health issues in them?
Conduct a literature search (using Medline AND CINAHL databases) and identify literature relevant
to the research question. APPEND THE SEARCH HISTORY TO THE ASSIGNMENT
Write a Literature Review that describes what is already known about your research question
(approx. word count 1,500)
According to Murphyet al. (2017), oxygen therapy that is long term is a familiar COPD’s
pharmacological treatment. Government records estimates that more than a total Medicare
population of one million get oxygen at home and that medical costs for such exceeds a total of $2
billion annually in the US. Pandya et al. (2019) notes that the application of oxygen in COPD condition
that is stable, with episodic hypoxemia related activity has given the required information in
explaining the significance of oxygen in the study population. The importance of oxygen in COPD
exacerbations can be therapeutic and toxic. Crucial information particularly from the UK, have
provided significant information regarding the concerned issue.
Long term oxygen therapy at home setting has showed improvement survival in patients with severe
resting hypoxemia and COPD. They further state that the support for LTOT is based on two landmark
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trials that were published close to forty years ago. They state that the results from the reimbursement
and prescription basis of LTOT to this very day. The work that has been done recently demonstrates
that there is no beneficial outcome of LTOT on patients with stable COPD having moderate
destruction during the activity or even at rest. Corrado, Renda and Bertini (2016) further note that
during activity and exercises, oxygen therapy has been shown to eliminate the symptoms and
maintain arterial saturation of oxygen, but not improve outcomes that are long term. There are
usually many functional, physiological and biological impacts that are associated with oxygen therapy
in COPD. Fraser et al. (2016) also notes that oxygen therapy in COPD exacerbations could be helpful at
the same time harmful. This is the reason why new guidance on application of oxygen therapy in the
prehospital care was published in the UK. The researchers also show that technological changes in the
Long-term oxygen therapy poses a challenge for prescriptions to physiology, medical equipment
suppliers that are durable, caregivers and patients. Even though the new technology in LTOT seemed
to be promising, it has hampered various regulatory processes and pressures. Lately, changes in the
reimbursement in the for Long term oxygen therapy also poses difficulties that sometimes are hard to
manoeuvre through. Pisani et al. (2017) claims that technology at the same time prove important but
because of reimbursements and cost constraints innovation has been limited.
Holm et al. (2017) observes that when taken together, the two different trials among the patients
show that the oxygen dose is essential. The treatment groups from NOTT nocturnal oxygen and MRC
showed a smaller duration in comparison to the group that was receiving continued oxygen from
NOTT. It is only the patients that were receiving continuous oxygen therapy that showed a decrease in
pulmonary and haematocrit vascular resistance. Comparing the groups in their study between the
subjects that were receiving oxygen demonstrated increase in median survival by 2-fold.
According to Ergan and Nava (2017), they assessed the effect of continued oxygen therapy on
pulmonary hemodynamic among the subjects of COPD and having resting hypoxemia. They showed
that from the starting point to the point of LTOT initiation, there was an evident worsening of
oxygenation and a continuous pressure increase of the pulmonary artery. Following LTOT, the
pressures in the pulmonary artery fall because of the decrease in the resistance of vascular
pulmonary. It is in this study that the data obtained forms the foundation for the use of ambulatory
oxygen at home signifying hypoxemia reversal with improved chances of survival, a salutary impact on
the pulmonary vascular resistance and supplemental oxygen. These findings are likely applicable to
patients with COPD and resting hypoxemia that is dated unfortunately. The effect of variations in the
caring of those with COPD suggest that LTOT should be visited. At the present however, there is a
clear evidence of the application of continuous oxygen therapy over therapy of nocturnal oxygen to
attain the required results.
Holm et al. (2017) observes that long term oxygen therapy is beneficial to the survival in patients with
chronic obstructive disease of pulmonary and severe hypoxemia to rest. According to the landmark
trials that were performed by the study, these benefits depends on the exposure time to oxygen.
They also note that following the introduction of oxygen concentrator, various studies have been
focusing on patient’s compliance to home oxygen therapy. In such a context, compliance refers to the
level at which the behaviours of the patients coincide with the prescription from the clinic, it has been
observed that compliance and adherence are similar and they could be used interchangeably. The
study’s evaluation on compliance of the patients on home oxygen mostly relied on reports from
patients based on the questionnaires and interviews. They further note that given the costs incurred
and the assumed relationship between the exposure time to oxygen and its importance on a person’s
survival, compliance then becomes an issue of interest. Similarly, understanding better of the home
oxygen therapy and it determinants may aid physicians and allied professionals of health in improving
patients’ care and cost effectiveness.
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According to Ergan and Nava (2017), many patients having severe COPD have a tendency of
developing hypoxemia at rest when awake as there is progression in their disease state. In some
instances, this may or might be accompanied by hypercapnia, however it remains to be a poor
prognostic feature and independent of the forced volume of expiration. For several years according to
Ekström et al. (2016), the scientific study of COPD has been largely driven by the need to gain an
understanding and comprehension of the processes which contributed to the disorders of gas
exchange. As a result, it led to the introduction of effective treatment aimed at increasing the arterial
oxygen tension a level beyond 8.0 kpa for 15 hours every day. The randomised control trials are the
building blocks of evidence based oxygen prescribing. Since the publication of these studies, the
oxygen therapy cost has progressively been increasing in different parts of the world as it is
embraced. Many patients with advanced COPD according to Murphyet al. (2017), rarely do they use
oxygen during exercising. Much more, they utilize oxygen to rapidly relieve their breathlessness and
this has broadly explained why there are large number of oxygen cylinders in people’s homes.
Nevertheless, many patients only choose their oxygen after breathlessness has been induced using
physical exercises.
Pisani et al. (2017) claims that in a study of individuals with COPD, when the treatment with oxygen
was compared with treatment by receiving air, those patients that were treated with oxygen felt less
breathless. Despite the experience, when the patients were asked to report what they preferred at
their individual level, they could not differentiate between the air and the oxygen. In other words, it is
difficult to explain whether the patients manifest the kind of the trade-off between exercise
performance and dyspnoea.
Murphyet al. (2017) observes that long term oxygen therapy does not contribute to the risk for
hospitalization or increase expectancy of life for significant number of patients with mild or moderate
COPD, however, it may lower the patient’s quality of life. For several decades, the physicians have
repeatedly prescribed long term oxygen therapy to patients having COPD based a research showing
that the therapy could extend their lives. However, these studies were carried out in the 1980s which
were significantly flawed. Researchers have realized that the more recent studies do not replicate the
old results. Throughout the field of medicine there are usually practices and treatments that continue
because they have always been employed and done to bring the desired change or outcome
according to Ekström et al. (2016). But it is important that physicians consider new evidence and
adjust accordingly. While there is little evidence of long term oxygen therapy, it is accompanied with
lots of challenges including the fact that it is expensive; patients are forced to pay out of their pockets
to sustain the Medicare. The most recent research by Pisani et al. (2017) shows that patients with
mild hyponexia do not benefit at all from the oxygen therapy unless they are faced with breathing
difficulties. The researchers still say that the measure is subjective and it could because of placebo
effect.
Most importantly, Karamanli et al. (2015) notes that there are usually side effects from getting the
therapy including irritation of the skin around the facemask or nasal cannula, the inside of one’s nose
becoming dry, getting nosebleeds occasionally and occasional headaches and fatigue especially in the
morning when waking up. They also note that there are usually complications that might come with
using oxygen therapy. Because it involves carrying around a tank or cylinder of oxygen, there is risk of
catching fire because oxygen supports burning. Thus it is always advised to stay at least five feet from
the source of open flame, avoid smoking or be near a person who is smoking and avoid taking the
oxygen tank into a confined place.
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How well does the existing literature address your research question?
In answering this question consider if your research question has been a) fully answered, b)
partially answered, or c) not answered at all.
THEN identify a) what further research could be conducted (and its characteristics such as design,
sample, outcome measures) that might provide important information to answer your research
question AND b) what are some ethical considerations that apply to these possible research studies
(approx. word count 400)
According to all studies mentioned above, it is notable that my research question has only been
partially answered. There has been no direct answer and most of the times the studies are giving a
focus on long term Oxygen therapy and not the general oxygen therapy. Most of the literature
reviewed from the study describe the importance of the long-term oxygen therapy to a patient who is
suffering from COPD. They also show that a person who is having COPD is at a higher probability of
developing hyponexia and therefore oxygen therapy helps in reducing the risk of developing other
complications including COPD progression. The studies reveal that the oxygen therapy could reduce
breathlessness, it could also restore quality of life of individuals. For example, there are times when
one may start feeling that they are getting better and the therapy may slowly be withdrawn. If it is
managed well according to the studies it is likely to ease breathing even though it has associated side
health effects.
Further research could be conducted in prognostic factors in COPD patients receiving oxygen therapy
that is long term and the role of pulmonary artery pressure in relation to Oxygen therapy. The study
ought to be a multivariate analysis of survival using Cox’s model of proportion hazards regression. The
sample population should be the people who have COPD and are on therapy. Measures on outcome
will then be done through comparison of the current state of the patients from their initial state and
determine whether there has been a significant difference or change.
Some of the ethical considerations in this kind of study is that the names of the patients should be
concealed to maintain confidentiality. Patient information is of utmost confidentiality and it should be
protected. The other ethical consideration that those conducting the research must seek the
permission and be approved by the health authorities so that they will be given a go ahead to
continue with their research as having been approved. This will also help when it comes to legal
liabilities. Another one is that those who will be participating in research (patients) should not be
subjected to any harm objectives of the researches aims and whatsoever at the expense of the
research. Lastly, there is the need to avoid any kind of deception or exaggeration concerning the aims
and objectives.
.
References
Corrado, A., Renda, T., & Bertini, S. (2016). Long-term oxygen therapy in COPD: evidences and open
questions of current indications. Monaldi Archives for Chest Disease, 73(1).
Ergan, B., & Nava, S. (2017). Long-term oxygen therapy in COPD patients who do not meet the
actual recommendations. COPD: Journal of Chronic Obstructive Pulmonary
Disease, 14(3), 351-366.
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Fraser, J. F., Spooner, A. J., Dunster, K. R., Anstey, C. M., & Corley, A. (2016). Nasal high flow
oxygen therapy in patients with COPD reduces respiratory rate and tissue carbon
dioxide while increasing tidal and end-expiratory lung volumes: a randomised crossover
trial. Thorax, 71(8), 759-761.
Holm, K. E., Casaburi, R., Cerreta, S., Gussin, H. A., Husbands, J., Porszasz, J., ... & Krishnan, J. A.
(2016). Patient involvement in the design of a patient-centered clinical trial to promote
adherence to supplemental oxygen therapy in COPD. The Patient-Patient-Centered
Outcomes Research, 9(3), 271-279.
Murphy, P. B., Rehal, S., Arbane, G., Bourke, S., Calverley, P. M., Crook, A. M., ... & Hurst, J. R.
(2017). Effect of home non-invasive ventilation with oxygen therapy vs oxygen therapy
alone on hospital readmission or death after an acute COPD exacerbation: a randomized
clinical trial. Jama, 317(21), 2177-2186.
Pandya, A., Criner, G., So, J., Jacobs, M. R., Thomas, J., & Criner, H. (2019). Tolerance and Safety
of Humidified High-Flow Nasal Cannula Oxygen Therapy in Patients Hospitalized with an
Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD). In B45. COPD:
TREATMENT (pp. A3327-A3327). American Thoracic Society.
Pisani, L., Fasano, L., Corcione, N., Comellini, V., Musti, M. A., Brandao, M., ... & Nava, S. (2017).
Change in pulmonary mechanics and the effect on breathing pattern of high flow oxygen
therapy in stable hypercapnic COPD. Thorax, 72(4), 373-375.
APPENDIX A: Search History of BOTH Medline & CINAHL
[APPEND SEARCH HISTORY HERE. CAN BE EITHER COPY & PASTED FROM WORD DOCUMENT OR A
PRINTSCREEN IMAGE OF SEARCH]
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