Ambulatory Oxygen Therapy From Narrative-Based Medicine: The Importance of Patient Experience in Care Plans

Introduction: Ambulatory Oxygen Therapy: Concepts, Uses And Indications

Oxygen therapy is a therapeutic technique that allows the controlled administration of oxygen at high concentrations (Ortega et al., 2014). Since its introduction in the 1960s (De la campa, 2014), it has been routinely used in the treatment of, among others, Chronic Obstructive Pulmonary Disease (COPD)¹, a condition that is one of the most common causes of hospital admission (Masclans, Pérez-Terán & Roca, 2015). In addition, it has also been used in many other situations where ventilation/perfusion is compromised, such as left heart failure, diffuse interstitial lung disease, pulmonary hypertension, and dyspnea secondary to neoplastic disease, hepato-pulmonary syndrome or patients with exclusive hypoxemia during physical activity, among others. (Codinardo et al., 2016). The goal is always to treat and/or prevent the manifestations of hipoxia², and thereby reduce respiratory and myocardial work, while increasing tolerance to exercise and Activities of Daily Living (ADL) (Salcedo et al., 2001).

Although the use is to a greater extent in the hospital, it can also be prescribed in the patient's own home on an outpatient basis, especially in a supplementary manner when the person in question is unable to perform normal physical exercise and/or daily activities (Bradley & O'Neill, 2007), something known as Continuous Home Oxygen Therapy (OCD) (González-Moro, Navarrete, Michavila & Lobato, 2016). The scientific literature has described, in detail, the benefits for people who use oxygen therapy at home. The time spent in the hospital is less, the social and family disadvantages of being in an institution for so long are less when staying in their natural environment surrounded by their people at any time, without the obligations and schedules that the institution establishes for the patient and his/her companions. All of these factors clearly improve the quality of life of the patient and his/her loved ones. In this sense, the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) establishes a series of indications that are necessary to be able to establish the oxygen therapy in the home, such as obtaining a stabilized situation for the patient, to receive the correct medical treatment, to give up the habit of smoking, and of course, to have the patient’s willingness to collaborate (SEPAR,2014).

When the time comes to start using OCD, the patient is forced to completely change his/her life habits, especially when it is often necessary that the therapy be applied at least 15 hours a day, including the hours of sleep, following the evidence provided by classical studies such as the Nocturnal Oxygen Therapy Trial or the British Medical Research Council, which demonstrated increased survival in patients with oxygen therapy, a survival that was greater the more hours of oxygen they received (Party, 1981; NOTT, 1980). A fact with which health professionals are often inflexible (Alonso & Sobradillo, 2004), forcing the person to spend a good part of the day at home or, in some cases, to use some kind of portable device³ which the patient must carry if he/she intends to go outdoors (Ruiz et al., 2014).