Optimizing implementation of adult domiciliary oxygen therapy in fibrotic interstitial lung disease
department or school: Medicine, Faculty of
department or school: Medicine, Department of
data provider: DSpace
degree campus: UBCV
creator: Saleem, Ferhan
issued: 2022-12-23T21:51:40Z
issued: 2022
related degree: Doctor of Philosophy - PhD
degree grantor: University of British Columbia
description: Background: Interstitial lung disease (ILD) is a collection of diseases that cause fibrosis and/or inflammation of lung parenchyma, often resulting in the adverse consequence of hypoxemia that can be alleviated by domiciliary oxygen. Objectives: 1) Derive and validate a risk model to predict new-onset exertional and resting hypoxemia in patients with ILD. 2) Identify oxygen guidelines worldwide and compare these to national domiciliary oxygen criteria. 3) Compare costs of domiciliary oxygen for patients with ILD and chronic obstructive pulmonary disease (COPD). Methods: 1) A multivariable model that predicted new-onset exertional and resting hypoxemia was derived and validated in international cohorts using time-varying Cox regression, with the final model optimizing Harrell's C-index and goodness-of-fit (GoF). 2) Clinical practice guidelines for domiciliary oxygen were identified and compared to oxygen criteria and funding source used by the 193 member countries in the United Nations obtained from an Internet-based literature review. 3) A retrospective chart review determined monthly costs of oxygen in ILD and COPD within a large domiciliary oxygen program from 2010-2017. Results: 1) The best-performing prediction model for both exertional and resting hypoxemia included age, body mass index, idiopathic pulmonary fibrosis diagnosis, percent-predicted forced vital capacity, and diffusing capacity of carbon monoxide. Good performance was exhibited for prediction of exertional (C-index=0.70, GoF=0.85) and resting hypoxemia (C-index=0.77, GoF=0.27) in the derivation cohort, with performance replicated in the validation cohort except for calibration for prediction of resting hypoxemia (GoF=0.001). 2) Guidelines for continuous oxygen were obtained for 30 respiratory societies and criteria for 46 countries with public funding for oxygen. No public funding was available in 145 countries (5.9 billion people). 3) Cost of oxygen declined after month 1 (ILD: ($202.57 ± $88.88 i…
aggregated CHO: https://circle.library.ubc.ca/rest/handle/2429/83518
note: OPTIMIZING IMPLEMENTATION OF ADULT DOMICILIARY OXYGEN THERAPY IN FIBROTIC INTERSTITIAL LUNG DISEASE by Ferhan Saleem B.Sc., University of Calgary, 2011 M.D., American University of Integrative Sciences, 2017 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in The Faculty of Graduate and Postdoctoral Studies (Experimental Medicine) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) December 2022 © Ferhan Saleem, 2022 ii The following individuals certify that they have read, and recommend to the Faculty of Graduate and Postdoctoral Studies for acceptance, the dissertation entitled: Domiciliary oxygen therapy and predicting hypoxemia in fibrotic interstitial lung disease submitted by Ferhan Saleem in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Experimental Medicine Examining Committee: Chris Ryerson, Associate Professor, Medicine, UBC Supervisor John Fleetham, Professor, Medicine, UBC Supervisory Committee Member Jordan Guenette, Assistant Professor, Medicine, UBC Supervisory Committee Member Najib Ayas, Associate Professor, Medicine, UBC University Examiner Ben Mortenson, Associate Professor, Medicine, UBC University Examiner iii Abstract Background Interstitial lung disease (ILD) is a collection of diseases that cause fibrosis and/or inflammation of lung parenchyma, often resulting in the adverse consequence of hypoxemia that can be alleviated by domiciliary oxygen. Objectives 1) Derive and validate a risk model to predict new-onset exertional and resting hypoxemia in patients with ILD. 2) Identify oxygen guidelines worldwide and compare these to national domiciliary oxygen criteria. 3) Compare costs of domiciliary oxygen for patients with ILD and chronic obstructive pulmonary disease (COPD). Methods 1) A multivariable model that predicted new-onset exertional and resting hypoxemia was derived and validated in international cohorts using time-varying Cox regression, with the final mo…
has type: Thesis/Dissertation
date issued: 2023-05
is shown at: 10.14288/1.0422901
language: eng
degree discipline: Experimental Medicine
provider: Vancouver : University of British Columbia Library
publisher: University of British Columbia
rights: Attribution-NonCommercial-NoDerivatives 4.0 International
rights URI: http://creativecommons.org/licenses/by-nc-nd/4.0/
scholar level: Graduate
contributor: Ryerson, Christopher J.
type: Text
identifier URI: http://hdl.handle.net/2429/83518