Home Oxygen Therapy in COPD

Indications and Eligibility

The European Respiratory Society recommends home oxygen therapy for patients with COPD who have severe hypoxemia at rest with PaO2 ≤7.3 kPa (55 mmHg) with or without hypercapnia, when the patient is clinically stable and on optimal medical treatment 2, 3, 4, 5
The American Thoracic Society indicates that home oxygen therapy is also recommended for patients with COPD who have a PaO2 between 7.3 and 8.0 kPa (55-59 mmHg) in the presence of pulmonary hypertension, peripheral edema, polycythemia, or severe nocturnal hypoxemia 2, 3, 4, 5

The British Thoracic Society recommends a minimum of 15 hours of oxygen therapy per day, including during sleep, to achieve benefits in survival 1, 2, 4, 5
The European Respiratory Society suggests that oxygen therapy should be used for as long as possible, preferably 24 hours a day, although a recent study found no additional benefits in survival with 24-hour oxygen therapy compared to 15-16 hours per day 3, 5

Nasal cannulas are the first choice for most patients, according to the American College of Chest Physicians 1
Oxygen concentrators are recommended for flows up to 4 L/min, as stated by the European Respiratory Society 1
Venturi masks may be considered for patients with concerns about hypercapnic respiratory failure, high respiratory rate at rest, or cognitive problems, as suggested by the British Thoracic Society 1

Ambulatory oxygen therapy may be offered to patients who cannot achieve 15 hours of oxygen use per day, as recommended by the American Thoracic Society 1
It improves exercise tolerance and dyspnea, and allows for greater adherence to home oxygen therapy, according to the European Respiratory Society 2, 4

Regular follow-up every six months is recommended, with periodic reassessment preferably through home visits by specialized healthcare personnel, as stated by the British Thoracic Society 2, 4

Home oxygen humidification should not be prescribed for patients without a tracheostomy, as warned by the American College of Chest Physicians 1
Oxygen-conserving devices may be used in patients who require high flows, as recommended by the European Respiratory Society 1