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Do You Need Long-Term Oxygen Therapy?

Long term oxygen therapy (LTOT) is defined as the provision of oxygen therapy for continuous use at home in patients who have chronic low blood oxygen levels (hypoxemia). It is usually administered for at least fifteen hours a day – including at night – if hypoxemia worsens during sleep. But do all patients with lung disease eventually need long term oxygen therapy?

Who Needs Long Term Oxygen Therapy?

Not everyone with a chronic lung disease like COPD needs long term oxygen therapy. According to the American Thoracic Society, appropriate candidates for LTOT include:1

  • Patients who are stable on a full medical regimen, with a partial pressure of oxygen (PaO2) as measured by arterial blood gases of less than 7.3KPa (55 mmHg), and an oxygen saturation level of 88% or less.
  • Patients who have a PaO2 of 7.3–7.8kPa (55-59  mmHg), an oxygen saturation level of 89%, and who show signs of tissue hypoxemia such as pulmonary hypertension, cor pulmonale,  edema from right-sided heart failure, polycythemia (high red blood cell count) or impaired mental status.

Patients who desaturate only during sleep or when they exercise may benefit from using supplemental oxygen specifically under these conditions. Moreover, because some gray areas remain, patients with adequate PaO2 who have severe shortness of breath or limited exercise capacity that improves with supplemental oxygen should talk to their doctors about whether they would qualify for, and indeed benefit from, long-term oxygen therapy.1

First Things First: Optimize Your Treatment Regimen

Correcting hypoxemia is one of the most important goals of COPD treatment, especially during and after a COPD exacerbation. The good news is that sometimes this can be done without the initiation of supplemental oxygen. The Nocturnal Oxygen Therapy Trial (NOTT) demonstrated that nearly half of the 203 patients who initially qualified for the study based on blood gas analysis alone improved to such a degree on bronchodilators, antimicrobials and corticosteroids that they no longer met criteria for the study based on their initial blood gases.2

During your initial evaluation for LTOT, your doctor should ensure that your medical treatment is optimal for whatever stage COPD you’re in. This includes paying particular attention to your medication regimen, your exacerbation history, and the presence of any other illnesses that may worsen your symptoms. If your treatment regimen is not optimal, but you meet criteria for LTOT as outlined above, the American Thoracic Society recommends that you be started on oxygen therapy and then reevaluated in 1-3 months to determine if you still need it.1

 

Author: Deborah Leader RN, BSN, PHN

 

1The American Thoracic Society. Home Oxygen Therapy: Appropriate Candidates for Long-Term Oxygen Therapy. 2013.
2Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: A clinical trial. Nocturnal oxygen therapy trial group. Ann Intern Med. 1980 Sep; 93(3):391-8.
 
 

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