The Medical Research Council and the Nocturnal Oxygen Therapy Trial studies clearly demonstrated that long-term oxygen therapy (LTOT) for more than 15 h/day improved mortality and morbidity in a well-defined group of patients with chronic obstructive pulmonary disease. There are no similar randomised control studies in patients with other hypoxaemic lung diseases such as pulmonary fibro-sis and pneumoconiosis. The prescription of oxygen for other restrictive lung disorders is complicated by hypoventilation requiring mechanical support as well as oxygen and should be restricted to special centres. The clearest indications for LTOT are for patients with cor pulmonale, hypoxic chronic bronchitis and emphysema, and in terminally ill patients who require palliation. Before LTOT is considered, the patient must be clinically stable and on appropriate optimum therapy such as antibiotics, bronchodilators, physiotherapy and having stopped smoking tobacco. Many patients first present for LTOT with profound hypoxaemia and hypercapnia during an infective, often oedematous exacerbation of their lung disease. Assessments should occur during convalescence when the patient is clinically stable. They should be shown to have a PaO2 < 7.3 kPa and/or a PaCO2 > 6 kPa on two occasions at least 3 weeks apart. FEV1 should be less than 1.5 litres, and there should be a less than 15% improvement in FEV1 after bronchodilators. All patients should be assessed by an experienced chest physician. Patients with a PaO2 between 7.3 and 8 kPa who have polycythaemia, right heart failure or pulmonary hypertension may gain benefit from LTOT but this is still to be clearly proven. More questionable indications are those patients with a PaO2 > 7.3 kPa by day who have episodes of profound hypoxaemia (arterial oxygen SaO2 < 85%) by night, and those patients with marked exercise hypoxaemia. Although correction of nocturnal hypoxaemia may be important, it is unlikely that the hypoxaemia of exercise affects survival or function at rest. Studies need to be performed in groups with these questionable indications and in patients with restrictive lung diseases before they can be added to the better defined indication for this costly therapy. Good home care support is mandatory for a successful outcome. Without home support patients do not adhere to therapy for the prescribed times. The availability of effective home care is as important to the prescription of LTOT as medical criteria.

Keywords:
Oxygen, Chronic obstructive pulmonary, disease, Nocturnal desaturation, Exercise hypoxaemia
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© 1992 S. Karger AG, Basel
1992
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