Long-term oxygen therapy (LTOT) improves survival, exercise, sleep, and cognition in patients with chronic obstructive pulmonary disease (COPD).
Oxygen sources include gas, liquid, and concentrator.
Oxygen delivery methods include nasal continuous flow, pulse demand, reservoir cannulas, and transtracheal catheter.
Physiological indications for oxygen include an arterial oxygen tension (PaO2) < 55 mm Hg. The therapeutic goal is to maintain arterial oxygen saturation (SpO2) > 90% during rest, sleep, and exertion.
Home oxygen therapy
Patients with COPD, whose disease is stable on a full medical regimen, with PaO2 < 55 mm Hg (corresponding to an SaO2 < 88 %), should receive LTOT.
A patient whose PaO2 is 55 to 59 mm Hg (SaO2 89%) and who exhibits signs of tissue hypoxia, such as pulmonary hypertension, cor pulmonale, erythrocytosis, edema from right heart failure, or impaired mental status, should also receive LTOT.
Desaturation only during exercise or sleep suggests consideration of oxygen therapy specifically under those conditions.
Some grey areas remain, such as patients with adequate PaO2 who have severe dyspnea relieved by low-flow oxygen or patients who are limited in their exertion capacity but improve their exercise performance with supplemental oxygen.
American Thoracic Society (ATS) and European Respiratory Society (ERS) 2004. Standards for the diagnosis and management of patients with COPD. Internet. Accessed on January 16, 2011.