Guideline issued on home oxygen therapy for chronic lung disease
Among other recommendations, patients with chronic lung disease and severe chronic resting hypoxemia should receive long-term oxygen for at least 15 hours per day, the American Thoracic Society said.
The American Thoracic Society recently released a clinical practice guideline on delivery of home oxygen therapy to patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease.
The guideline was developed by a multidisciplinary panel and based on a systematic review of the literature. Clinical recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The guideline was published Nov. 15 by the American Journal of Respiratory and Critical Care Medicine.
The panel strongly recommended long-term oxygen use for at least 15 hours per day in patients with COPD (moderate-quality evidence) or interstitial lung disease (very low-quality evidence) who have severe chronic resting hypoxemia on room air. Severe chronic resting hypoxemia was defined as a PaO2 of 55 mm Hg (7.3 kPa) or less or oxygen saturation as measured by pulse oximetry (SpO2) of 88% or less, or as a PaO2 of 56 to 59 mm Hg (7.5 to 7.9 kPa) or SpO2 of 89% plus one of the following: edema, hematocrit of 55% or greater, or P pulmonale on an ECG. The panel also made conditional recommendations:
- against long-term oxygen use in patients with COPD with moderate chronic resting hypoxemia, defined as an oxygen saturation of 89% to 93% (low-quality evidence);
- for ambulatory oxygen use in patients with COPD (moderate-quality evidence) or interstitial lung disease (low-quality evidence) who have severe exertional hypoxemia on room air; and
- for use of ambulatory liquid oxygen in patients with chronic lung disease who are mobile outside the home and require at least 3 L of continuous-flow oxygen per minute during exertion (very low-quality evidence).
The panel also issued a best practice statement recommending that patients and their caregivers receive education on oxygen equipment and safety, including tripping hazards, smoking cessation, and fire prevention. They noted that the available evidence on home oxygen therapy is lacking and that more research is necessary, since supplemental oxygen is commonly prescribed.
“We urge the research community and funding agencies to work together to develop a stronger evidence base that will guide clinical practice for oxygen prescription,” the authors wrote. “Of critical importance is the involvement of engineers and those in related fields who can combine creativity with applied science to develop methods of raising arterial blood oxygen content to normal levels, even during intense exercise, without the burdens associated with current oxygen delivery systems.”
An article in the October ACP Internist offered tips for clinicians on choosing home oxygen for patients.