Oxygen in patients with fibrotic interstitial lung disease: aninternational Delphi survey

Rationale Patients with fibrotic interstitial lung disease frequently develop resting or exertional hypoxemia. There is heterogeneity in clinical practice and a paucity of evidence guiding supplemental oxygen use in this patient population. The objectives of this study were to build international expert-based consensus on the indications and goals of supplemental oxygen from the perspective of health-care providers, and identify potential barriers to its access. Methods Semi-structured interviews and a comprehensive literature search informed items for the Delphi survey, with items not meeting consensus included in the second round. The third round contained survey questions regarding regional funding coverage for oxygen therapy. A priori definitions of consensus were median scores of 4 (agree) to 5 (strongly agree) for “agreement”, 1 (strongly disagree) to 2 (disagree) for “disagreement”, or 3 (unsure) with an interquartile range of 0 to 1. Results 42/45 (93%) experts completed all three survey rounds, representing 17 countries. 20/36 items met consensus for agreement or disagreement, ten items met consensus for unsure, and five items did not meet consensus. Experts agreed that oxygen should be recommended for patients with severe exertional hypoxemia, and in cases of exertional desaturation to <85–89%, particularly with attributable symptoms or exercise limitation. There are regional differences in funding coverage for oxygen, based on desaturation thresholds, clinical symptoms and testing requirements. Conclusions Experts achieved consensus on 20 items guiding supplemental oxygen use in fibrotic interstitial lung disease. These data may inform research, clinical recommendations, and funding policy.