A reminder that SAIL renewal test notifications are being sent to the client and to the home oxygen company who will request an order from the physician for home oxygen testers to complete testing.

Previously, the renewal forms were distributed to clients and physicians (changed last June). There were issues with:
 renewal forms not being returned
 individuals being sent for testing although the renewal form stated that testing was not required
 renewal forms being returned without testing attached
 renewals being rejected because no testing was attached and patients being sent for more testing 
 renewal forms being modified by unknown parties to state testing was not required when it is, etc.

SAIL would prefer that physicians return the completed renewal form (prescription) to the vendor – one change to be made in the early new year will be to update the top right corner of the renewal which currently still states “return to SAIL”. A change has already been made at the bottom of the form stating to return it to the vendor.

Amyotrophic Lateral Sclerosis (ALS) is a progressive disease with degeneration of motor neurons in the brain and spinal cord causing weakness, muscle atrophy, fasciculations and spasticity. The etiology of ALS is not fully understood, likely resulting from a complex interplay between genetics and environmental factors. ALS can affect the respiratory muscles used to breathe. The nerves that control the breathing muscles do not work correctly, and the muscles become weak. Although this usually occurs in late stages of the disease, in some cases it can occur in the early stages. Weak breathing muscles can make it challenging to take a deep breath. Patients with ALS start to breathe shallowly as a result which affects their ability to effectively exchange air in the lungs.

Non-invasive ventilation (NIV) is recommended for people diagnosed with ALS who meet specific criteria per the Canadian Best Practice Guidelines for ALS Management. NIV is a machine that supports a persons breathing using either nasal or full face mask. Generally patients with ALS are prescribed a Bi-level positive airway pressure (BiPAP), which is a type of NIV, that delivers two pressure levels: a higher pressure when a person inhales and a lower pressure when a person exhales. The BiPAP compensates for diaphragm weakness and helps improve overall quality of life for those living with ALS. A person is generally assessed every three months by a respirologist who determines if NIV is an appropriate treatment option. Timely testing is important for people diagnosed with ALS as their respiratory status can change quickly. This includes overnight oximetry which may be ordered by a respirologist to determine if NIV is to be considered.

Oxygen should not be considered a routine treatment for chronic respiratory insufficiency. In patients with ALS with acute hypoxemia, management of respiratory insufficiency with NIV needs to be considered first. If hypoxemia remains after optimal NIV pressure is applied, the etiology of the hypoxia needs to be assessed and supplemental oxygen can be considered.

If a respirologist determines that oxygen therapy should be utilized, it is recommended to utilize oxygen therapy together with BiPAP to ensure they are able to effectively breath out carbon dioxide and avoid hypoxemia.

Kala Bolt (she/her), RN BSN, CNN

Clinical Nurse Coordinator – ALS/MND Clinic
Saskatoon City Hospital - Saskatoon

References:

Canadian best practice recommendations for the management of amyotrophic lateral sclerosis - CMAJ 2020 November 16;192:E1453-68. doi: 10.1503/cmaj.191721

ALS Guide – ALS Society https://www.als.ca/wp-content/uploads/2020/03/ALS-guide-ON-EN-WEB.pdf

We are so excited to announce that Home Oxygen Tester Training has transitioned to an online, independent-learning module that can be taken anytime.

Anyone can take the course for 2 HOURS of continuing education credit but, as always, only Saskatchewan Health Authority employees will receive home oxygen tester numbers and certification.

If you are a current tester, you can recertify by completing this online course.

Please contact oxygentest@lungsask.ca if you have questions. Feedback on the course is also welcome and considered.