Long-Term Oxygen Therapy

Abstract

n a first pilot study in 1967, Levine and colleagues (1) found that oxygen delivery to patients with chronic obstructive pulmonary disease (COPD) and hypoxemia improved pulmonary hypertension and increased exercise performance (1). As a result, oxygen supplementation developed as a therapeutic measure in chronic hypoxemia. However, there is still insufficient evidence for oxygen therapy, as it is essentially based on two studies from the early 1980s (2, 3). This review provides an overview of the current evidence, with the aim of examining the practical, day-today aspects of long-term oxygen therapy (LTOT). Methods This article is based on a selective literature search in PubMed. Publications from January 1980 to April 2018 were searched using the terms "long-term oxygen therapy," "ambulatory oxygen therapy," "nocturnal oxygen therapy," and "supplemental oxygen." Current German and international guidelines (in German or English) were also included. Results Long-Term Oxygen Therapy For chronic hypoxemic patients with an arterial partial pressure of oxygen (PaO 2) ≤ 55 mm Hg, national guidelines for LTOT recommend giving oxygen for at least 15 hours per day (4) or for 16 hours per day (5); this should be extended to 24 hours for increased efficacy (see section "Indication criteria for LTOT") (4, 5). This includes targeted oxygen replacement during exercise and at night. As studies do not consider these different situations of oxygen deficiency separately, the effects of these three therapeutic approaches cannot be delimited. The goals of LTOT are to improve quality of life and exercise performance, as well as to reduce morbidity and mortality (5). Effects of LTOT LTOT for chronic hypoxemia The currently validated evidence for prescribing LTOT is based on two randomized controlled trials published in the early 1980s (2, 3). In the so-called MRC (Medical Research Council) trial, 87 COPD patients (FEV 1 , 0.6 L) were included who had pronounced chronic hypoxemia (PaO 2 = 51 mm Hg) and hypercapnia (PaCO 2 = 54 mm Hg) in a resting state; they were then Summary Background: Long-term oxygen therapy (LTOT) is an established treatment for patients with chronic hypoxemia. Its scientific basis is derived mainly from two trials from the early 1980s that showed a survival advantage for patients with chronic obstructive pulmonary disease (COPD) treated with LTOT. Robust data are not available for other diseases associated with hypoxemia. Methods: This review is based on pertinent publications retrieved by a selective search in PubMed. Results: The use of LTOT for 15 to 16 hours per day (or, better, 24 hours per day) is recommended in current guidelines for patients with chronic hypoxemia (PaO 2 ≤ 55 mm Hg) because this treatment was found to be associated with a lower mortality rate compared to no LTOT (33% vs. 55%, p <0.05) based on data from the early 1980s. In the short term, oxygen administration to a hypoxemic patient can improve oxygen saturation by nine percentage points and improve physical performance to a clinically re...

Utility and outcomes among Indigenous and non‐Indigenous patients requiring domiciliary oxygen therapy in the regional and rural Australian population

“…3,4 Efforts to understand the benefits of therapeutic interventions, such as DOT, may be crucial in reducing the morbidity and mortality in this population to facilitate closing the gap in health outcomes. Despite some controversies in the literature regarding DOT, 18 results of our study demonstrate that DOT may be helpful among patients with a diagnosis of COPD/bronchiectasis among Indigenous patients living in remote and regional communities. However, further studies are warranted.…”

“…14,15 However, supplemental oxygen therapy also known as 'domiciliary oxygen therapy' (DOT) or 'ambulatory oxygen therapy' (AOT) or 'long term oxygen therapy' (LTOT) is a recommended treatment modality for patients with chronic hypoxaemia. 16 Although there is conflicting and contradicting information in the literature regarding the utility of DOT/LTOT, 17,18 the therapeutic benefits of supplemental oxygen therapy include amelioration of symptoms of hypoxemia and prevention or delay end-organ dysfunction, thereby resulting in reduced morbidity and mortality, and improved quality of life. 19 The majority of supporting evidence for the use of DOT comes from studies based on patients with COPD.…”

Progressive pulmonary fibrosis: an expert group consensus statement

“…3) Patients with borderline hypoxaemia not meeting the requirements for LTOT may still benefit from LTOT due to reduction in breathlessness [ 110 ], but LTOT should be considered only after other causes of hypoxia have been excluded.…”

Short term home oxygen therapy COVID-19 patients: The COVID-HOT algorithm

“…Its primary aims include the improvement of quality of life and reduction in morbidity and mortality. [ 17 63 64 ] In contrast, short-term oxygen therapy (STOT) is generally less well studied, and its applications are fairly heterogeneous. [ 65 66 67 ] More specifically, the use of STOT in COVID-19 patients is based on the primarily hypoxic pathophysiology of SARS-CoV-2 pulmonary damage.…”