long-term oxygen therapy (LTOT) in COPD
Last edited 02/2021 and last reviewed 05/2021
- long-term oxygen therapy (LTOT)
- clinicians should be aware that inappropriate oxygen therapy in people with COPD may cause respiratory depression
- LTOT can be defined as oxygen used for at least 15h per day in chronically hypoxaemic patients
- chronic hypoxaemia is defined as a PaO2 <=7.3kPa or, in certain clinical situations, PaO2 <=8.0kPa
- patients with stable chronic obstructive pulmonary disease (COPD) and a resting PaO2 <=7.3kPa should be assessed for LTOT which offers survival benefit and improves pulmonary haemodynamics
- LTOT should be ordered for patients with stable COPD with a resting PaO2 <=8kPa with evidence of peripheral oedema, polycythaemia (haematocrit >=55%) or pulmonary hypertension (2)
- LTOT should be ordered for patients with resting hypercapnia if they fulfil all other criteria for LTOT (2)
- oxygen concentrators should be used to provide the fixed supply at home for long-term oxygen therapy
- patients should be warned about the risks of fire and explosion if they
continue to smoke when prescribed oxygen
- ambulatory oxygen therapy
- people who are already on LTOT who wish to continue with oxygen therapy outside the home, and who are prepared to use it, should have ambulatory oxygen prescribed
- ambulatory oxygen therapy should be considered in patients who have exercise desaturation, are shown to have an improvement in exercise capacity and/or dyspnoea with oxygen, and have the motivation to use oxygen
- ambulatory oxygen therapy is not recommended in COPD if PaO2 is greater than 7.3 kPa and there is no exercise desaturation
- ambulatory oxygen therapy should only be prescribed after an appropriate assessment has been performed by a specialist. The purpose of the assessment is to assess the extent of desaturation, and the improvement in exercise capacity with supplemental oxygen, and the oxygen flow rate required to correct desaturation
- small light-weight cylinders, oxygen-conserving devices and portable liquid oxygen systems should be available for the treatment of patients with COPD
- a choice about the nature of equipment prescribed should take account
of the hours of ambulatory oxygen use required by the patient and the
oxygen flow rate required
- short-burst oxygen therapy
- short-burst oxygen therapy should only be considered for episodes of severe breathlessness in patients with COPD not relieved by other treatments
- short-burst oxygen therapy should only continue to be prescribed if an improvement in breathlessness following therapy has been documented
- when indicated, short-burst oxygen should be provided from cylinders
- non-invasive ventilation (NIV)
- adequately treated patients with chronic hypercapnic respiratory failure who have required assisted ventilation (whether invasive or non-invasive) during an exacerbation or who are hypercapnic or acidotic on LTOT should be referred to a specialist centre for consideration of long-term NIV
For more detailed guidance then see the full BTS guideline.
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