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Home oxygen therapy effective in treating bronchiolitis
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Home oxygen therapy successfully treated children with bronchiolitis, and should be considered for integration into ED care, along with stringent follow-up procedures, according to a study published in Pediatrics.
Kelly B. Flett, MD, of Boston’s Children’s Hospital, and colleagues followed 234 children discharged from the ED on home oxygen for bronchiolitis. Median age at discharge was 10 months. Ten children (4.3%) had a gestational age of less than 35 weeks. Eleven children (4.7%) were previously diagnosed with reactive airways disease; 35 (15%) children were previously diagnosed with bronchiolitis; and 43 children (18.4%) had either one or both diagnoses in the past. Thirty-six children (15.4%) were given a nebulizer in the ED.
Eight children (3.4%) were diagnosed with reactive airways disease or prescribed albuterol; seven (3%) were diagnosed with pneumonia. While nearly all children (99.1%) were prescribed ≤0.5 L/minute of oxygen, two were prescribed 1 L/minute of oxygen. Seven children (3%) reported oxygen delivery issues, including failure of delivery and broken components.
Regarding treatment, 212 children (90.6%) were managed with home oxygen therapy only. The median length of use was 6 days; 65.5% of children discontinued oxygen by 7 days and 93.3% discontinued oxygen by 14 days. Eleven children required oxygen for 15 to 22 days. One child was required to use oxygen for 39 days. Another was required to continue use for 425 days and was later diagnosed with interstitial lung disease.
Researchers found the length of oxygen therapy was associated with age younger than 6 months and a gestational age less than 37 weeks. The median length of oxygen therapy for children aged younger than 6 months was 9 days, compared with 6 days for children aged 6 to 18 months and 5 days for children aged more than 18 months.
Twenty-two children (9.4%) were readmitted after they had been discharged with home oxygen therapy. Reasons for admission included increased work of breathing or respiratory rate (72.7%); increased oxygen requirement (45.4%); pneumonia (22.7%); intravenous fluids (4.5%); parental concern (4.5%); and failure of oxygen delivery (4.5%).
“Our results reveal that home oxygen can be feasibly integrated into ED care for bronchiolitis in a primarily Medicaid population with good adherence to recommend follow-up. There is significant outpatient demand associated with home oxygen use, requiring mechanisms for follow-up or expanded clinic availability. Future programs will have to address these needs before implementation,” the researchers concluded.
Disclosure: The researchers have no relevant financial disclosures.
Perspective
Back to TopHeikki Peltola, MD
Denver, CO, lies at an altitude of approximately 1600 m, which in part, may explain special interest in the home oxygen therapy in bronchiolitis. No less than 37% of children with bronchiolitis attending the main hospital’s (Denver Health) emergency department are started with oxygen. Since hypoxia complicates three out of four cases, and prolongs hospital stay by 1.6 days, one questions if the hospital-started treatment could be continued at home.Flett and colleagues analyzed retrospectively 234 children from the years 2003-2009 whose oxygen treatment for bronchiolitis was materialized entirely (91%) or partly (9%) at home. Thirteen percent, 75%, and 12% of the patients aged younger than 6 months, 6 to 18 months, and older than 18 months, respectively. The median length of oxygen use was 6 days (IQR: 4-9 days). The duration of oxygen therapy associated with age younger than 6 months and gestational age younger than 37 weeks. In all, 22 (9%) children were readmitted to the hospital because of various reasons, mainly due to increased work for breathing, increased oxygen requirement, or pneumonia. All children survived. The authors conclude that there is a significant out-patient demand for oxygen use at home.
I have some problems in apprehending the real benefits of the home oxygen therapy in bronchiolitis, as it seems to speed up the discharge by a few days, at most. However, patients not residing at or near the sea level may have special requirements. Also each “extra” day in hospital is costly, and not only in the sense of money. However, that expenditure must be projected against all the troubles and costs due to the setup of a well-functioning administration of oxygen at home, not to forget the concern of parents. As 35% of children received oxygen for longer than a week, many children received this therapy unnecessarily long which, of course, added to the total sum of treatment.
This said, there certainly are patients whose home oxygen therapy is of great benefit to themselves and the family. In acute bronchiolitis their number, I think, is rather small.
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