Background Minimising hypoxemia during submaximal walking tests has a positive effect on exercise capacity and dyspnea in patients with COPD on long–term oxygen therapy (LTOT). However, the impact of optimising oxygenation during everyday tasks remains unexplored. Therefore, we investigated the effects of maintaining a target saturation on activities of daily living (ADL) using automated oxygen titration compared to conventional fixed oxygen flow. Methods In a double–blinded, randomised crossover trial, 31 patients with COPD on LTOT performed two GlittreADL tests to assess the functional capacity of everyday activities using a) their fixed oxygen dose and b) an adjusted flow from 0–8 L/min targeting a SpO2 of 90–94%. A closed loop device automatically titrated the oxygen based on information from a Bluetooth wrist pulse oximeter. Results The patients reduced the time to perform the ADL-test by median (IQR) 38 (12–73) seconds, p<0.001, using automated titration compared to the fixed oxygen flow. The oxygen flow in the automated arm more than tripled to 5.4 (4.1–6.8) vs. 1.6 (1.1–2.1) L/min (fixed) during the test, p<0.001, while the time spent within SpO2–target was increased from 19% to 49%, p=0.002. Correspondingly, the patients experienced less dyspnea (BorgCR10); 5 (3–7) vs. 6 (4–8), p<0.001, in favour of the automated oxygen titration. Conclusions Improving oxygenation and extending the time spent within target saturation reduced dyspnea and improved functional capacity in activities of daily living in patients with COPD on LTOT. Trial registration number NCT05553847

The principal investigator has no competing interest regarding this study. The funding received, covered salary and expenses conducting the trial. EFH is a co-inventor of O2matic and hold shares in the company. O2matic Aps is not involved in the study. Apart from the above conflict of interest the remaining investigators have none.

NCT05553847

The study was funded by Innovation Fund Denmark grant nr. 8056-00054B, Swedish Respiratory Society and The Association of Danish Physiotherapists Research Fund.

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This study was approved by the Regional Research Ethics Committee of the Capital Region of Denmark (H-22032988)

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All data produced in the present study are available upon reasonable request to the authors