Use of supplemental oxygen therapy in idiopathic pulmonary fibrosis: an observational real-life study in 16 003 patients.

Background and objectives: The use of long-term oxygen therapy (LTOT) in idiopathic pulmonary fibrosis (IPF) is poorly studied. We assessed the proportion of patients with IPF receiving LTOT and compared the risk of death according to LTOT exposure.

Methods: Using the French national healthcare claims database, the use of LTOT and antifibrotics was studied in patients newly diagnosed with IPF from 1 January 2012 to 31 December 2019, followed until 31 December 2021. An adjusted Cox regression model was used to compare the risk of death by LTOT use, using exposure to antifibrotics and LTOT as time-dependent variables.

Results: Among 16 003 patients newly diagnosed with IPF, 4559 (28.5%) initiated LTOT during follow-up: median time to initiation was 273 days and median duration was 336 days. The proportion of patients initiating LTOT was 23.2% among those not receiving antifibrotics (78.5% of study population) and 42.0% in those treated by antifibrotics at inclusion (7.7%), with respective median time to LTOT initiation of 110 and 590 days, and respective median LTOT duration of 308 and 294 days. Patients exposed to LTOT had a significantly higher risk of death compared with those who were not (HR: 2.9 (95% CI: 2.8 to 3.0) among those without antifibrotics; 2.1 (95% CI 1.9 to 2.3) among those with concomitant antifibrotics).

Conclusions: The use of LTOT is limited among patients with IPF, even those receiving antifibrotics. The association between LTOT and mortality suggests that LTOT use is a marker of severity. Guidelines dissemination would help clinicians adopt appropriate LTOT management in patients with IPF and chronic respiratory failure.