UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Long-term supplemental oxygen therapy

Authors
Brian L Tiep, MD
Rick Carter, PhD, MBA
Section Editor
James K Stoller, MD, MS
Deputy Editor
Helen Hollingsworth, MD

INTRODUCTION

Long-term oxygen therapy (LTOT) increases survival and improves the quality of life of hypoxemic patients with chronic obstructive pulmonary disease (COPD) [1-14]. Each year, approximately one million patients receive LTOT through Medicare, at a cost exceeding two billion dollars per year [13]. This cost is increasing at an annual rate of nearly 13 percent.

Because LTOT is a costly therapy, Medicare reimbursement for its prescription is tightly regulated. In this topic review, we describe the benefits of LTOT and indications for its use. In addition, we address practical issues including reimbursement, documenting the patient's need for LTOT, and the process of prescribing LTOT that is necessary for the patients to receive their oxygen. Continuous oxygen delivery systems, high-flow nasal cannula, portable oxygen delivery, and oxygen conserving devices are discussed separately. (See "Continuous oxygen delivery systems for infants, children, and adults" and "Portable oxygen delivery and oxygen conserving devices".)

BENEFITS

Four randomized, controlled trials have evaluated the effect of long-term oxygen therapy (LTOT) on mortality in patients with COPD. Two of the trials, the Nocturnal Oxygen Therapy Trial (NOTT) and the Medical Research Council (MRC) trial, demonstrated improved survival among patients that received LTOT (figure 1 and figure 2), including correlation between survival and the average daily duration of oxygen use [1,2]. In contrast, two trials found no effect of LTOT on survival [4,15].

An important difference between these trials was the inclusion criteria [13]. The trials that demonstrated a survival benefit included patients with more severe resting hypoxemia (arterial oxygen tension [PaO2] ≤60 mmHg [7.98 kPa]) than the trials that showed no benefit (PaO2 <69 mmHg [9.18 kPa]), indicating that individuals with less severe hypoxemia may not derive survival benefit from LTOT.

LTOT may improve outcome measures other than mortality, including quality of life, cardiovascular morbidity, depression, cognitive function, exercise capacity, and frequency of hospitalization [3,5-12,16,17]. Improved quality of life was demonstrated in a prospective study that measured health related quality of life (using the St. Georges Respiratory Questionnaire [SGRQ]) before and after six months of LTOT delivered via a concentrator [16]. Prior to therapy, health related quality of life was worse among the patients with COPD who had hypoxemia (and had already been receiving LTOT for at least six months via a cylinder), compared to patients with COPD who were not hypoxemic. After six months of LTOT, health-related quality of life had improved and was similar in both groups. This suggests that LTOT improves quality of life and the improvement is related, at least in part, to the time spent using supplemental oxygen, which also relates to the delivery system(s) used. The effect of combining concentrators and portable devices to improve mobility and further enhance quality of life has yet to be determined. Prescribing oxygen during exertion with highly portable lightweight devices without the support of a pulmonary rehabilitation program may or may not lead to a more active lifestyle.

                 

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu Aug 11 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group. Ann Intern Med 1980; 93:391.
  2. Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Report of the Medical Research Council Working Party. Lancet 1981; 1:681.
  3. Eaton T, Lewis C, Young P, et al. Long-term oxygen therapy improves health-related quality of life. Respir Med 2004; 98:285.
  4. Chaouat A, Weitzenblum E, Kessler R, et al. A randomized trial of nocturnal oxygen therapy in chronic obstructive pulmonary disease patients. Eur Respir J 1999; 14:1002.
  5. Stewart BN, Hood CI, Block AJ. Long-term results of continuous oxygen therapy at sea level. Chest 1975; 68:486.
  6. Heaton RK, Grant I, McSweeny AJ, et al. Psychologic effects of continuous and nocturnal oxygen therapy in hypoxemic chronic obstructive pulmonary disease. Arch Intern Med 1983; 143:1941.
  7. Weitzenblum E, Oswald M, Apprill M, et al. Evolution of physiological variables in patients with chronic obstructive pulmonary disease before and during long-term oxygen therapy. Respiration 1991; 58:126.
  8. Borak J, Sliwiński P, Tobiasz M, et al. Psychological status of COPD patients before and after one year of long-term oxygen therapy. Monaldi Arch Chest Dis 1996; 51:7.
  9. Clini E, Vitacca M, Foglio K, et al. Long-term home care programmes may reduce hospital admissions in COPD with chronic hypercapnia. Eur Respir J 1996; 9:1605.
  10. Okubadejo AA, Paul EA, Jones PW, Wedzicha JA. Does long-term oxygen therapy affect quality of life in patients with chronic obstructive pulmonary disease and severe hypoxaemia? Eur Respir J 1996; 9:2335.
  11. Ringbaek TJ, Viskum K, Lange P. Does long-term oxygen therapy reduce hospitalisation in hypoxaemic chronic obstructive pulmonary disease? Eur Respir J 2002; 20:38.
  12. Haidl P, Clement C, Wiese C, et al. Long-term oxygen therapy stops the natural decline of endurance in COPD patients with reversible hypercapnia. Respiration 2004; 71:342.
  13. Croxton TL, Bailey WC. Long-term oxygen treatment in chronic obstructive pulmonary disease: recommendations for future research: an NHLBI workshop report. Am J Respir Crit Care Med 2006; 174:373.
  14. Stoller JK, Panos RJ, Krachman S, et al. Oxygen therapy for patients with COPD: current evidence and the long-term oxygen treatment trial. Chest 2010; 138:179.
  15. Górecka D, Gorzelak K, Sliwiński P, et al. Effect of long-term oxygen therapy on survival in patients with chronic obstructive pulmonary disease with moderate hypoxaemia. Thorax 1997; 52:674.
  16. Tanni SE, Vale SA, Lopes PS, et al. Influence of the oxygen delivery system on the quality of life of patients with chronic hypoxemia. J Bras Pneumol 2007; 33:161.
  17. Yamamoto H, Teramoto S, Yamaguchi Y, et al. Long-term oxygen administration reduces plasma adrenomedullin levels in patients with obstructive sleep apnea syndrome. Sleep Med 2007; 9:80.
  18. Nonoyama ML, Brooks D, Guyatt GH, Goldstein RS. Effect of oxygen on health quality of life in patients with chronic obstructive pulmonary disease with transient exertional hypoxemia. Am J Respir Crit Care Med 2007; 176:343.
  19. Quantrill SJ, White R, Crawford A, et al. Short burst oxygen therapy after activities of daily living in the home in chronic obstructive pulmonary disease. Thorax 2007; 62:702.
  20. Sjöberg F, Singer M. The medical use of oxygen: a time for critical reappraisal. J Intern Med 2013; 274:505.
  21. Austin MA, Wills KE, Blizzard L, et al. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ 2010; 341:c5462.
  22. Amani H, Lozano DD, Blome-Eberwein S. Brother, have you got a light? Assessing the need for intubation in patients sustaining burn injury secondary to home oxygen therapy. J Burn Care Res 2012; 33:e280.
  23. Murabit A, Tredget EE. Review of burn injuries secondary to home oxygen. J Burn Care Res 2012; 33:212.
  24. Sharma G, Meena R, Goodwin JS, et al. Burn injury associated with home oxygen use in patients with chronic obstructive pulmonary disease. Mayo Clin Proc 2015; 90:492.
  25. Carlos WG, Baker MS, McPherson KA, et al. Smoking-Related Home Oxygen Burn Injuries: Continued Cause for Alarm. Respiration 2016; 91:151.
  26. Anderson BW, Greenlund AC, Greenlund LJ. Facial hair: a newly identified, modifiable risk factor in home oxygen therapy-related burns. Mayo Clin Proc 2014; 89:1164.
  27. Snider GL. Enhancement of exercise performance in COPD patients by hyperoxia: a call for research. Chest 2002; 122:1830.
  28. Somfay A, Porszasz J, Lee SM, Casaburi R. Dose-response effect of oxygen on hyperinflation and exercise endurance in nonhypoxaemic COPD patients. Eur Respir J 2001; 18:77.
  29. Tiep B, Carter R, Zachariah F, et al. Oxygen for end-of-life lung cancer care: managing dyspnea and hypoxemia. Expert Rev Respir Med 2013; 7:479.
  30. Doherty DE, Petty TL, Bailey W, et al. Recommendations of the 6th long-term oxygen therapy consensus conference. Respir Care 2006; 51:519.
  31. American Thoracic Society / European Respiratory Society Task Force. Standards for the Diagnosis and Management of Patients with COPD [Internet]. Version 1.2. New York: American Thoracic Society; 2004 [updated 2005 September 8]. Available from: http://www-test.thoracic.org/copd/ (Accessed July 9, 2009).
  32. Neff TA, Petty TL. Long-term continuous oxygen therapy in chronic airway obstruction. Mortality in relationship to cor pulmonale, hypoxia, and hypercapnia. Ann Intern Med 1970; 72:621.
  33. Tiep BL, Barnett J, Schiffman G, et al. Maintaining oxygenation via demand oxygen delivery during rest and exercise. Respir Care 2002; 47:887.
  34. Palwai A, Skowronski M, Coreno A, et al. Critical comparisons of the clinical performance of oxygen-conserving devices. Am J Respir Crit Care Med 2010; 181:1061.
  35. Emtner M, Porszasz J, Burns M, et al. Benefits of supplemental oxygen in exercise training in nonhypoxemic chronic obstructive pulmonary disease patients. Am J Respir Crit Care Med 2003; 168:1034.
  36. Fletcher EC, Miller J, Divine GW, et al. Nocturnal oxyhemoglobin desaturation in COPD patients with arterial oxygen tensions above 60 mm Hg. Chest 1987; 92:604.
  37. Fletcher EC, Luckett RA, Goodnight-White S, et al. A double-blind trial of nocturnal supplemental oxygen for sleep desaturation in patients with chronic obstructive pulmonary disease and a daytime PaO2 above 60 mm Hg. Am Rev Respir Dis 1992; 145:1070.
  38. Petty TL, O'Donohue WJ Jr. Further recommendations for prescribing, reimbursement, technology development, and research in long-term oxygen therapy. Summary of the Fourth Oxygen Consensus Conference, Washington, D.C., October 15-16, 1993. Am J Respir Crit Care Med 1994; 150:875.
  39. Office of the Inspector General, Office of Audit Services. Results of national review of the medical necessity for oxygen concentrators. Audit Control No. A–04–88–02058, 1990.
  40. Medicare Program Integrity Manual, Chapter 5. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/pim83c05.pdf (Accessed on April 12, 2016).
  41. New problems in supply, reimbursement and certification of medical necessity for long–term oxygen therapy. Am Rev Respir Dis 1990; 142:721.
  42. Problems in prescribing and supplying oxygen for Medicare patients. Am Rev Respir Dis 1986; 134:340.
  43. Further recommendations for prescribing and supplying long–term oxygen therapy. Am Rev Respir Dis 1988; 138:745.
  44. Petty TL, Casaburi R. Recommendations of the Fifth Oxygen Consensus Conference. Writing and Organizing Committees. Respir Care 2000; 45:957.
  45. Zieliński J. Long-term oxygen therapy in conditions other than chronic obstructive pulmonary disease. Respir Care 2000; 45:172.
  46. O'Donohue WJ Jr. Transtracheal oxygen: a step beyond the nasal cannula for long-term oxygen therapy. Nebr Med J 1992; 77:291.
  47. Christopher KL, Spofford BT, Petrun MD, et al. A program for transtracheal oxygen delivery. Assessment of safety and efficacy. Ann Intern Med 1987; 107:802.
  48. Sharp C, Adamali H, Millar AB. Ambulatory and short-burst oxygen for interstitial lung disease. Cochrane Database Syst Rev 2016; 7:CD011716.
  49. Nishiyama O, Miyajima H, Fukai Y, et al. Effect of ambulatory oxygen on exertional dyspnea in IPF patients without resting hypoxemia. Respir Med 2013; 107:1241.
  50. Troy L, Young I, Munoz P, et al. Does supplemental oxygen increase exercise endurance in patients with idiopathic pulmonary fibrosis? Respirology 2014; 19:95.
  51. Arizono S, Taniguchi H, Sakamoto K, et al. Benefits of supplemental oxygen on exercise capacity in IPF patients with exercise-induced hypoxemia. Eur Respir J 2015; 46:OA4971.