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

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 (SpO2). 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 SpO2 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 SpO2. During the control period, patients received their usual fixed dose oxygen. Feasibility was defined as time with automated titration, time within target SpO2 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 SpO2 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 SpO2 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 SpO2 needs to be examined in a larger study.