Pilot Study: Post-Recovery LibEration From Oxygen in Exacerbated COPD
Pilot Study: Post-Recovery LibEration From Oxygen in Exacerbated COPD
The investigators want to decrease inappropriate oxygen use for patients with COPD who have
 recovered from a recent hospitalization. The investigators are testing a new program that
 will stop oxygen prescriptions for patients that no longer need it and will instead provide
 them with training in skills that have been shown to help patients breathe better.
 Participants will be randomly assigned to receive the intervention program or usual care.
 After 12 weeks the investigators will determine if the program helped stop unnecessary oxygen
 prescription. The investigators will also determine if health status, distance walked during
 six minutes, and symptoms of breathlessness after walking are different between participants
 who received the program and those who did not. The investigators will meet with
 participating patients and their providers after the study is complete to find out how they
 feel about this program and if it would be possible to put this change into practice.
The purpose of this pilot study is to test an intervention designed to decrease inappropriate
 oxygen use for patients with COPD who have recovered after a recent hospitalization.
 Participants will be randomized to usual care vs. an oxygen de-implementation intervention.
 Patients assigned to the oxygen de-implementation intervention group will have their active
 oxygen prescription discontinued, be educated on pursed lip breathing and receive inhaler
 training. A follow-up assessment will occur at 12 weeks. The primary outcome at 12 weeks will
 be discontinuation of oxygen. Secondary outcomes include health status as measured by the
 Clinical COPD Questionnaire (CCQ), tele-six minute walk test (6MWT) distance, and Borg
 dyspnea scale assessed after the tele-6MWT. Among the intervention group, the investigators
 will also assess acceptability and feasibility of the intervention for patient participants
 and their providers.
Inclusion Criteria:

 -  Age 40 years or older

 -  Diagnosis of COPD

 -  Discharged within the past 3 months after hospitalization for COPD exacerbation,
 congestive heart failure exacerbation and/or pneumonia

 -  Active prescription for supplemental oxygen within 48 hours of discharge that remains
 active

 -  No inpatient or outpatient exacerbations of COPD within the last 30 days

 -  Smoked at least 10 pack-years of cigarettes

 -  Room air resting saturation >88% on room air

 -  Spirometry consistent with COPD (FEV1/FVC < 0.70) and/or evidence of emphysema on CT
 scan

 -  Willingness on the part of the participant to stop oxygen if randomized to the
 intervention

 -  Ability and willingness to participate in virtual video visits with study staff using
 VA approved software

 -  Agreement in writing from patient's clinician to rescind the oxygen order if
 randomized to intervention group

 -  Informed consent for participation

 Exclusion Criteria:

 -  Desaturation during 6MWT <80% for one minute or more

 -  Non-COPD lung disease that affects oxygenation or survival (including pulmonary
 hypertension)

 -  Prescription of oxygen for alternative condition (e.g. bleed-in with positive airway
 pressure therapy for obstructive sleep apnea)

 -  Diagnosis expected to result in death in six months or enrollment in hospice

 -  Participation in another intervention trial

 -  Cognitive issues that would preclude participation (dementia, stroke, etc.)

 -  Residence in skilled nursing facility

 -  Inability to speak, read, or understand English

 -  Any safety concerns