Patients with severe COPD commence oxygen therapy at home many years before the disease reaches the terminal phase.
Long term oxygen therapy extends life expectancy in hypoxemic COPD patients if given for 12-15 hours a day – five-year survival in 41% of patients.
• Non smoking patient with stable, severe COPD – FEV1 < 1.5L and arterial hypoxemia - <7.3 Kpa (55 mmHg)
• COPD patients with clinically stable PaO2 between 7.3 and 8 KPa ( 55-60 mmHg), associated with polycythemia, nocturnal hypoxia, peripheral edema, or evidence of pulmonary hypertension
LTOT is not recommended for patients with PaO2 > 8 KPa
Oxygen concentrator is cheap and more convenient than cylinders
Ambulatory oxygen therapy uses lightweight oxygen cylinders and is used in patients who are ambulant and have the need to move about and leave home. Those who smoke cigarettes should not be prescribed ambulatory oxygen as there is a considerable risk from burns.
Mode of administration
: nasal cannula
Rate of flow
: 1-3 L/min usually achieves a saturation of > 90%; the rate is increased by 1L at night and during exercise to prevent desaturation.
Leach RM. Palliative Care in Non-Malignant, End-Stage Respiratory Disease. Hanks G, Cherny NI, Christakis NA, Fallon M, Kaasa S, Portenoy RK (Ed).Oxford Textbook of Palliative Medicine. Oxford University Press, Fourth Edition, 2010, pp. 1231-1256.