Home oxygen therapy: evidence versus reality

ABSTRACT

Introduction: LTOT is a well-established treatment option for hypoxemic patients. Scientific evidence for its benefits of LTOT dates back to the 1980s, when two randomized controlled trials showed prolonged survival in COPD-patients undergoing LTOT for at least 15 hours/day. In contrast, the potential benefits of LTOT in non-COPD-patients has not been well researched and the recommendations for its application are primarily extrapolated from trials on COPD-patients. Recently, a large trial confirmed that COPD-patients who don’t meet classic indication criteria, and have moderate desaturation at rest or during exercise, do not benefit from oxygen therapy. Also the significant technical evolution of LTOT devices has improved its application.

Areas covered: A literature research was performed in pubmed regarding home oxygen therapy (terms: LTOT, ambulatory oxygen therapy, short burst oxygen therapy, nocturnal oxygen therapy).

Expert commentary: LTOT proved a survival benefit for COPD patients about 30 years ago. Whether the results of these trials are still valid for patients under modern treatment guidelines remains unknown. Nevertheless, the classic indication criteria for LTOT still persist in guidelines, since there is a lack of updated evidence for the effects of LTOT in more severe hypoxemic patients.

KEYWORDS:

• Long-term oxygen therapy (LTOT)
• COPD
• ILD
• guidelines
• ambulatory oxygen therapy (AOT)
• nocturnal oxygen therapy (NOT)

Acknowledgments

Dr. Sandra Dieni is acknowledged for proof-reading the manuscript and Dr. Marieke Duiverman for translating the Dutch guideline on COPD.

Declaration of interest

F.S. Magnet and J.H. Storre received personal travel grants and speaking fees from companies dealing with LTOT and home mechanical ventilation. WW received speaking fees from companies dealing with LTOT. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

The study group received an open research grant from Weinmann/Germany, Vivisol/Germany, Heinen und Löwenstein/Germany, and VitalAire/Germany.