Domiciliary pulse-oximetry at exacerbation of chronic obstructive pulmonary disease: prospective pilot study

Title: Domiciliary pulse-oximetry at exacerbation of chronic obstructive pulmonary disease: prospective pilot study
Authors: Hurst, JR
Donaldson, GC
Quint, JK
Goldring, JJP
Patel, ARC
Wedzicha, JA
Item Type: Journal Article
Abstract: BACKGROUND: The ability to objectively differentiate exacerbations of chronic obstructive pulmonary disease (COPD) from day-to-day symptom variations would be an important development in clinical practice and research. We assessed the ability of domiciliary pulse oximetry to achieve this. METHODS: 40 patients with moderate-severe COPD collected daily data on changes in symptoms, heart-rate (HR), oxygen saturation (SpO2) and peak-expiratory flow (PEF) over a total of 2705 days. 31 patients had data suitable for baseline analysis, and 13 patients experienced an exacerbation. Data were expressed as multiples of the standard deviation (SD) observed from each patient when stable. RESULTS: In stable COPD, the SD for HR, SpO2 and PEF were approximately 5 min(-1), 1% and 10l min(-1). There were detectable changes in all three variables just prior to exacerbation onset, greatest 2-3 days following symptom onset. A composite Oximetry Score (mean magnitude of SpO2 fall and HR rise) distinguished exacerbation onset from symptom variation (area under receiver-operating characteristic curve, AUC = 0.832, 95%CI 0.735-0.929, p = 0.003). In the presence of symptoms, a change in Score of ≥1 (average of ≥1SD change in both HR and SpO2) was 71% sensitive and 74% specific for exacerbation onset. CONCLUSION: We have defined normal variation of pulse oximetry variables in a small sample of patients with COPD. A composite HR and SpO2 score distinguished exacerbation onset from symptom variation, potentially facilitating prompt therapy and providing validation of such events in clinical trials.
Issue Date: 20-Oct-2010
Date of Acceptance: 20-Oct-2010
URI: http://hdl.handle.net/10044/1/32386
DOI: http://dx.doi.org/10.1186/1471-2466-10-52
ISSN: 1471-2466
Publisher: BioMed Central
Journal / Book Title: BMC Pulmonary Medicine
Volume: 10
Copyright Statement: © Hurst et al. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​2.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Activities of Daily Living
Aged
Female
Heart Rate
Humans
Male
Monitoring, Ambulatory
Oximetry
Oxygen
Pilot Projects
Pulmonary Disease, Chronic Obstructive
Respiratory System
1102 Cardiovascular Medicine And Haematology
Publication Status: Published
Article Number: 52
Appears in Collections:National Heart and Lung Institute
Airway Disease
Faculty of Medicine



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