Long-term oxygen therapy: Are we prescribing appropriately?

Abstract

Long-term oxygen therapy (LTOT) is the treatment proven to improve survival in chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure. It also appears to reduce the number of hospitalizations, increase effort capacity, and improve health-related quality of life. Standard LTOT criteria are related to COPD patients who have PaO2 <60 mmHg, are in a clinical stable situation, and are receiving optimal pharmacological treatment. According to LTOT guidelines, oxygen should be prescribed for at least 18 hours per day although some authors consider 24 hours would be more beneficial. The benefits of LTOT depend on correction of hypoxemia. Arterial blood gases should be measured at rest. During exercise, an effort test should be done to assure adequate SaO2. During sleep, continuous monitoring of SaO2 and PaCO2 should be performed to confirm correction of SaO2 overnight. An arterial blood gas sample should be taken at awakening to assess PaCO2 in order to prevent hypoventilation from the oxygen therapy. Several issues that need to be addressed are the use of LTOT in COPD patients with moderate hypoxemia, the efficacy of LTOT in patients who desaturate during exercise or during sleep, the optimal dosage of oxygen supplementation, LTOT compliance, and the LTOT prescription in diseases other than COPD.

Assessment of health status and program performance in patients on long-term oxygen therapy

“…This is the case of Sweden [7,9,29À32] that: (i) created a national registry administered by the Swedish Respiratory Society, (ii) enforced an innovative workflow, and, (iii) generated 9 indices for longitudinal evaluation of LTOT. They have generated positive outcomes that contributed to increase the interest on LTOT [2,7,8,33].…”

“…The current study was prompted by the hypothesis that patients on Long-Term Oxygen Therapy (LTOT) may present requirements that could be efficiently covered by community-based ICS with potential to improve LTOT outcomes and raise healthcare efficiencies [2].…”

Is ‘GOLD’ standard for the management of COPD in clinical practice?

“…Support includes education on how and why to use oxygen, and ways to overcome the self-consciousness of using a treatment that is very conspicuous [ 1 ]. Successful long-term oxygen therapy is dependent (at least in part) upon coping skills, motivation and a supportive family influence [ 123 ].…”

Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations

“…[393394395] These include patients with moderate daytime hypoxemia, only nocturnal hypoxemia, and only exercise-induced hypoxemia. A recent analysis found no benefit of oxygen therapy in patients with moderate daytime hypoxemia or nocturnal hypoxemia alone.…”