Long-term oxygen therapy: are we prescribing appropriately?

Rosa Güell Rous, Rosa Güell Rous

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 PaCO, 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.

Figures

Figure 1
Figure 1
Comparison of survival curves of NOTT and MRC studies. The poorest prognosis was in the MRC controls who received no oxygen. The best survival was in the NOTT patients who received oxygen for >19 hours/day. Copyright © 1980, 1981. Modified with permission from [NOTT] Nocturnal Oxygen Therapy Trial Group. 1980. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group. Ann Inter Med, 93:391–8; [MRC] Medical Research Council Working Party. 1981. Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Report of the Medical Research Council Working Party. Lancet, 1:681–5. Abbreviations: MRC, Medical Research Council; NIH, National Institutes of Health; NOTT, Nocturnal Oxygen Therapy Trial.
Figure 2
Figure 2
Evolution of PaCO2 ▪: oxygen flow titrated at daytime,▴: 1 litre increase in oxygen flow. Note: p < 0.05 Samolski et al in press. Abbreviation: PaCO2, partial pressure of oxygen in arterial blood.
Figure 3
Figure 3
Evolution of pH▪: oxygen flow titrated at daytime,▴: 1 litre increase in oxygen flow. Note: p < 0.05 Samolski et al in press.

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