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Background: Hypoxemia is a cardinal feature of fibrotic interstitial lung disease (ILD). The incidence, progression, and prognostic significance of hypoxemia in patients with fibrotic ILD currently is unknown., Research Question: What are the epidemiologic features of hypoxemia and its additive prognostic value in a current risk prediction model of fibrotic ILD?, Methods: We identified 848 patients with fibrotic ILD (258 with idiopathic pulmonary fibrosis [IPF]) in five prospective ILD registries from Australia, Canada, and Switzerland. Cumulative incidence of exertional and resting hypoxemia from the time of diagnosis was estimated at 1-year intervals in patients with baseline 6-min walk tests, adjusted for competing risks of death and lung transplantation. Likelihood ratio tests were used to determine the prognostic significance of exertional and resting hypoxemia for 1-year mortality or transplantation when added to the ILD-GAP model. The cohort was divided into derivation and validation subsets to evaluate performance characteristics of the extended model (the ILD-GAP-O 2 model), which included oxygenation status as a predictor., Results: The 1-, 2-, and 5-year overall cumulative incidence was 6.1%, 17.3%, and 40.1%, respectively, for exertional hypoxemia and 2.4%, 5.6%, and 16.5%, respectively, for resting hypoxemia, which were significantly higher in patients with IPF compared with patients without IPF (P < .001 for both). Addition of exertional or resting hypoxemia to the ILD-GAP model improved 1-year mortality and transplantation prediction (P < .001 for both). The ILD-GAP-O 2 model showed improved discrimination (C-index, 0.80 vs 0.75) and model fit (Akaike information criteria, 400 vs 422) in the validation cohort, with comparable calibration., Interpretation: Patients with IPF have higher cumulative incidence of exertional and resting hypoxemia than patients without IPF. The extended ILD-GAP-O 2 model provides additional risk stratification for 1-year prognosis in fibrotic ILD., (Copyright © 2021 American College of Chest Physicians. All rights reserved.)

Purpose of Review: Supplemental oxygen therapy is prescribed for management of hypoxaemia in patients with interstitial lung disease (ILD). This review summarizes current evidence and implications of the use of supplemental oxygen therapy at home and during exercise training in ILD., Recent Findings: Despite the significance of hypoxaemia in patients with ILD, there is a lack of high-quality evidence to guide the use of oxygen therapy in this population. Recent studies suggest that ambulatory oxygen may improve symptoms and health-related quality of life in patients with ILD. Long-term oxygen therapy for resting hypoxaemia in ILD is recommended by international guidelines. Supplemental oxygen during exercise may augment training effects, whereas therapeutic effects of nocturnal oxygen therapy are yet to be evaluated in patients with ILD. Nevertheless, it is important to consider the potential burden imposed by oxygen therapy on patients' daily activities of living., Summary: Ambulatory oxygen may be considered in ILD patients with exertional hypoxaemia, with long-term oxygen therapy being a standard care for resting hypoxaemia. Trials are currently underway to clarify therapeutic potentials of supplemental oxygen for exertional hypoxaemia and during exercise training in ILD patients, with additional research needed for the evaluation of nocturnal oxygen therapy.

Rationale: Domiciliary oxygen therapy (DOT) is commonly prescribed for patients with interstitial lung disease (ILD) and hypoxemia, although evidence supporting benefit is limited., Objectives: The aim of this study was to explore perspectives of respiratory physicians about DOT in patients with ILD., Methods: A qualitative study was undertaken with 26 respiratory physicians from Australia. Interviews were transcribed verbatim and coded independently by two investigators. Themes were established by consensus., Results: Physicians reported symptomatic relief as the main indication for prescribing DOT in ILD. Concerns were raised regarding the applicability of current clinical guidelines for DOT to ILD. Compared with patients with other lung diseases, there was a lower threshold for DOT prescription for patients with ILD. Physicians perceived that patients with ILD complied better with recommended DOT prescription. There was significant variation in infrastructure for oxygen assessment and prescription, patient support, and equipment provision among institutions and states. Various patients' attitudes and experiences toward DOT were reported, but most notable was physicians' perception of significant anxiety in most patients using DOT because of social stigma and concerns that DOT signified end-stage disease., Conclusions: Oxygen therapy was primarily prescribed for symptomatic management in patients with ILD. Education provision and supports regarding DOT varied significantly.

Rationale: Domiciliary oxygen therapy is commonly prescribed for patients with interstitial lung disease and hypoxemia, either at rest or during exertion, with the aim of improving symptoms and functional status., Objectives: This study aimed to explore perspectives of adults with interstitial lung disease about domiciliary oxygen therapy, comparing insights from patients using and not using oxygen therapy., Methods: A qualitative study using semistructured interviews was undertaken on 24 adults residing in and near Melbourne, Australia who had a diagnosis of interstitial lung disease and met the Thoracic Society of Australia and New Zealand guidelines for domiciliary oxygen therapy. Study subjects included individuals who were oxygen-naive (n = 12) and oxygen-experienced (n = 12). Interviews were transcribed verbatim and coded independently by two investigators in accordance with the grounded theory method of analysis. Themes were established by consensus., Results: Patients using domiciliary oxygen therapy described widespread variation in usage. Oxygen-naive patients expected oxygen therapy to relieve dyspnea, whereas oxygen-experienced patients emphasized the benefits of oxygen on other, non-dyspnea-related physical symptoms. Practical and psychosocial challenges of using oxygen therapy were raised by both groups of patients., Conclusions: This study highlights the different expectations and experiences of domiciliary oxygen therapy for adults with interstitial lung disease. It is important to understand and address patients' concerns about the use of oxygen therapy for these patients.