Manufacturers are providing patients with more options and more freedom to integrate their oxygen therapy into their lives, a fact that improves compliance, outcomes, and quality of life.
There are millions of people diagnosed with chronic obstructive pulmonary disease (COPD) around the world and 15 percent of these are prescribed oxygen. The number of COPD patients coming into the market is increasing and is expected to continue to increase for many more years. COPD patients are also increasingly being prescribed oxygen until the end of their life expectancy combined with the fact that COPD is being diagnosed earlier in life due to an increased awareness of the condition which means that many more people will be requiring oxygen for longer periods of time. The most recent offerings in oxygen delivery products are continuing the industry's emphasis on smaller, lighter, and more reliable technology. Together, manufacturers are providing patients with more options and more freedom to integrate their oxygen therapy into their lives, a fact that improves compliance, outcomes, and quality of life.
Advances in design have transformed portable oxygen concentrators (POCs) from the bulky size they were previously, to the lightweight units that are no bigger than a child's lunchbox. The reason behind this size shift can be credited to the new on-demand system. This on-demand design allows for the concentrator mechanism to be comprised of smaller components. This newer system keeps any wasted oxygen to a minimum by having the POC work in conjunction with the patient's breathing cycle, only providing oxygen as needed. For the most part, on-demand POCs work on settings that are consistent with a liter-per-minute (LPM) delivery format. The device utilizes a bolus system, which is measured in milliliters. The bolus size is calculated based on the quantity of oxygen inhaled, if the person was on a continuous flow of oxygen. That consistent amount of oxygen is then delivered during the patient's inhalation phase of respiration. This technology removes the inefficiencies of wasted oxygen that is unnecessary during the exhalation phase. Due to advances in technology, the boluses can be changed to a variable function based on a patient's respiratory rate. This is significant, regarding the use of an on-demand machine while the patient is sleeping, as the patient's respirator rate slows significantly while they are asleep. The variable bolus is able to detect slower respiratory rates and subsequently adjust the bolus, thereby offering a longer delivery time during the inhalation phase.
The Indian market for oxygen concentrators in 2015 continued to grow at 15 percent. Stationary oxygen concentrators dominate the market, with government constituting 20 percent of the market. In the portable segment, the private sector holds the entire market share.
Philips is a clear leader in this segment. Airsep , which had a dominant share in 2015, is exiting the segment in 2016. Taurus and Medicare had success with the government tenders in 2015, albeit at 25 percent lower price levels. Invacare also has strong presence in this segment. NRHM has invited a tender for 10,000 units in 2016.
Pulse-dose technology to vouch for. Pulse-dose technology, a relatively new development in oxygen therapy, is incorporated in most new oxygen concentrators. Traditionally, oxygen concentrators provided a continuous supply of oxygen, regardless of whether the patient was inhaling or exhaling. A pulse-dose system delivers oxygen in fixed increments that corresponds to the inhalation component of a patient's breathing cycle. In doing so, pulse-dose technology prevents oxygen from being wasted and increases efficiency of an oxygen concentrator. Pulse-dose technology is particularly important in portable oxygen concentrators, which have limited storage. It is an on-demand delivery system for low-concentration oxygen therapy that can provide the same oxygen saturation to patients at a much lower volume per minute than continuous-flow oxygen. Pulse-dose systems aim to increase the oxygen tank duration and battery life of the concentrator and allow adjustable oxygen delivery, as well as smaller, more wearable machines. Delivering the oxygen bolus early in inspiration provides patients with the same oxygen concentration as continuous-flow oxygen.
Long-term oxygen therapy (LTOT). LTOT has entered a new era as a result of technological developments such as portable oxygen concentrators, concentrator-compressors, and, in the future, concentrator-liquefiers. The smaller size of these oxygen delivery systems can improve patients' mobility and quality of life. Recent advances in LTOT have resulted in increased use of portable oxygen concentrators and decreased use of liquid oxygen tanks, with reduced costs to the healthcare system. LTOT improves quality of life and the improvement is related, at least in part, to the time spent using supplemental oxygen, which also relates to the delivery systems used. The effect of combining concentrators and portable devices to improve mobility and further enhance quality of life has yet to be determined. Prescribing oxygen during exertion with highly portable lightweight devices without the support of a pulmonary rehabilitation program may or may not lead to a more active lifestyle.
The sources of stationary oxygen are compressed gas, concentrator, or liquid oxygen. For the patients who move only occasionally, large portable oxygen system like steel cylinders on wheel may be used. However, those who seek further freedom and independent movements, a much lighter-weight ambulatory oxygen system, which may be carried by the patient with satisfactory duration of support, may be used. The choice of the system depends on the cost, availability, and the need of the patient. The delivery devices may be nasal cannulae, prong, or mask. A humidifier may or may not be attached to the system with its inherent advantages and disadvantages. Different oxygen-conserving devices are designed in order to improve portability of oxygen therapy so that an ambulatory device can be used for a longer period of time and also reduce the total cost of LTOT by reducing wastage of oxygen.
Importance of pulse oximeters. Hypoxemia can be detected by monitoring the oxygen saturation of the patient with a pulse oximeter. Monitoring oxygen saturation is important to determine whether oxygen treatment is effective and to prevent overtreatment. While a blood gas analyzer can be used to determine the partial pressure of oxygen in blood, a simpler, inexpensive, and non-invasive method is pulse oximetry. Pulse oximetry is the preferred method to measure the oxygen saturation in arterial blood.
Various pulse oximeters are available in the market. Either bench-top (AC-powered) or hand-held pulse oximeters can be used, depending on the financial, electrical, and staff resources available. Hand-held oximeters are cheaper than their larger counterparts, but most hand-held oximeters have batteries that require replacement, which could be very easily lost, stolen or unavailable in certain LRS. Where theft or loss of hospital equipment is a major risk, it may be sensible to secure the oximeter in one location within the ward, within reach of the sickest patients. An alternative is to have a locked chain securing the oximeter to a bracket on a wall or bench, with the key kept by the nurse-in-charge of each shift.
POCs versus liquid oxygen (LOX). LOX and POCs are the two main forms of oxygen therapy, and while both have their benefits and drawbacks, POC is becoming the preferred choice among patients. Liquid oxygen is stored in small, compressed tanks and transforms to gaseous oxygen when heated. One liter of LOX offers about 860 liters of gaseous oxygen, and LOX is available in a variety of tank sizes. Tanks are relatively small and lightweight compared to other compressed oxygen types, allowing patients to carry several. Still, this does limit a patient to how long they can be mobile before having to come home and refill their tanks. Refilling is the biggest drawback to LOX. When a home refill unit is exhausted, the patient must wait for a supplier to come to the house to fill it back up. This drives up the cost of liquid oxygen systems.
The main advantage of a POC is that it does not require oxygen tanks. The device works by taking ambient air and stripping certain elements, like nitrogen and argon, and supplying users with 93 percent pure oxygen. Storage reservoir of pressurized oxygen is not required so it is lighter than LOX, and recent advances in POC development allow them to be built less cumbersome than previous models, increasing independence, convenience, and mobility. However, because the unit must essentially generate its own oxygen, this puts additional burden on the unit, which runs on internal batteries, automobile adaptors, or standard electricity.
This need for a continuous power source can make some patients feel tied down, especially when the batteries have been drained. Still, the cost benefits seem to be outweighing the power drawbacks, as liquid oxygen is falling off in favor of POCs.
Challenges and Opportunities
The main inhibiting factor on the advancement of POCs is the highly competitive nature that the industry has evolved into. This has led to providers dramatically lowering prices in order to maintain market share, which is highly beneficial to the patient; however, it leaves less money available for re-investment into research to drive improvements. With the steep increasing trend of COPD diagnosis around the world, it seems there will be an ever-increasing number of patients and therefore providers seeking to purchase POCs, which will then still allow for re-investment.
Future oxygen concentrator technologies will continue to be focused on clinically sound therapy but may incorporate much more software and intelligence in the design. In a future clinical world of evidence-based care, compliance, and outcomes, data will continue to gain importance. Concurrently, as providers face higher operational costs and lower payments, the technology will need to be more intelligent and continue to eliminate unnecessary and costly non-value-added activities.