Virtual oxygen assessment feasible, safe for adults with cystic fibrosis
Virtual oxygen assessments were a safe and feasible method for reviewing ambulatory oxygen requirements in adults with cystic fibrosis, according to results of a pilot study.
“We have been in the midst of a global pandemic for coming up to 2 years now and, as such, virtual solutions to assessments and patient monitoring have been expedited and paramount to maintaining contact with our patients, most of whom in the cystic fibrosis population are in the highly vulnerable category,” Tom M. Tobin, BSc, specialist physiotherapist at the Royal Brompton Hospital, London, said during a presentation at the North American Cystic Fibrosis Conference.
Recent approval of elexacaftor/tezacaftor/ivacaftor triple therapy (Trikafta/Kaftrio, Vertex Pharmaceuticals) “has meant that a lot of our patients in our clinic have had improved health status,” Tobin said. “As a result, lots of people who have been using ambulatory oxygen have felt that they no longer need to use it, and people have stopped using it, which is a bit of a worry when we haven’t got any objective measures of whether this is correct or whether actually in fact, although they feel better, they still desaturate on exercise or ambulation and require supplementary oxygen to make to maintain saturations about 90%.”
Tobin and colleagues conducted a pilot study of 10 patients with cystic fibrosis (median age, 35 years; 40% women) who were on triple therapy and required a review of their oxygen demands through reports by a physiotherapist or part of the medical team. Researchers arranged a time and date for a virtual assessment and mailed pulse oximeters to patients who did not already have one at home. The virtual assessment consisted of a video call and the addition of an accompanying adult with the patient in case of adverse events.
The researchers developed a 3-minute step test, which resulted in exertional desaturation to the same extent as the 6-minute walk test but was more feasible considering at-home restrictions. Patients self-reported their heart rates, saturations and breathlessness, and researchers used these data to guide oxygen prescription and discussed prescriptions with the patient.
Nine patients had oxygen in place at home and one patient did not; for this patient, researchers estimated and prescribed oxygen equipment to be sent to their home prior to the assessment date. A 6-minute walk test was performed by one patient who had the space, the 3-minute step test was performed by eight patients, and one patient used their home exercise plan with the researchers monitoring their saturation and breathlessness.
Oxygen was removed in two patients. Another two patients had unchanged oxygen requirements. However, oxygen requirements changed in 60% of cases; three resulted in a decrease and three resulted in an increase in level.
No adverse events were reported. Two 3-minute step tests were prematurely concluded due to breathlessness; both patients who discontinued their 3-minute step test returned to baseline observations after 3 resting minutes.
According to Tobin, cystic fibrosis care models moving forward may continue containing virtual elements as many patients struggle reporting to hospitals for clinic appointments not only due to the pandemic, but due to personal conflicts as well.
“Further research into the validity and the sensitivity of the 3-minute step test as a tool for monetary exertional desaturation is needed,” Tobin said. “Lots of our other teams within the hospital — non-[cystic fibrosis] bronchiectasis, asthma, COPD — have also found virtual solutions to their clinical appointments. So, if they have patients that they need to review their oxygen requirements or concerns that their oxygen prescription might be outdated or incorrect, this could be a potential solution to that as well.”