oxygen therapy in chronic obstructive pulmonary disease (COPD)

Last edited 02/2021 and last reviewed 05/2021

  • long-term oxygen therapy (LTOT)
    • clinicians should be aware that inappropriate oxygen therapy in people with COPD may cause respiratory depression
    • LTOT can be defined as oxygen used for at least 15h per day in chronically hypoxaemic patients
      • chronic hypoxaemia is defined as a PaO2 <=7.3kPa or, in certain clinical situations, PaO2 <=8.0kPa
      • patients with stable chronic obstructive pulmonary disease (COPD) and a resting PaO2 <=7.3kPa should be assessed for LTOT which offers survival benefit and improves pulmonary haemodynamics
      • LTOT should be ordered for patients with stable COPD with a resting PaO2 <=8kPa with evidence of peripheral oedema, polycythaemia (haematocrit >=55%) or pulmonary hypertension (2)
      • LTOT should be ordered for patients with resting hypercapnia if they fulfil all other criteria for LTOT (2)

    • oxygen concentrators should be used to provide the fixed supply at home for long-term oxygen therapy
    • patients should be warned about the risks of fire and explosion if they continue to smoke when prescribed oxygen

  • ambulatory oxygen therapy
    • people who are already on LTOT who wish to continue with oxygen therapy outside the home, and who are prepared to use it, should have ambulatory oxygen prescribed
    • ambulatory oxygen therapy should be considered in patients who have exercise desaturation, are shown to have an improvement in exercise capacity and/or dyspnoea with oxygen, and have the motivation to use oxygen
    • ambulatory oxygen therapy is not recommended in COPD if PaO2 is greater than 7.3 kPa and there is no exercise desaturation
    • ambulatory oxygen therapy should only be prescribed after an appropriate assessment has been performed by a specialist. The purpose of the assessment is to assess the extent of desaturation, and the improvement in exercise capacity with supplemental oxygen, and the oxygen flow rate required to correct desaturation
    • small light-weight cylinders, oxygen-conserving devices and portable liquid oxygen systems should be available for the treatment of patients with COPD
    • a choice about the nature of equipment prescribed should take account of the hours of ambulatory oxygen use required by the patient and the oxygen flow rate required

  • short-burst oxygen therapy
    • short-burst oxygen therapy should only be considered for episodes of severe breathlessness in patients with COPD not relieved by other treatments
    • short-burst oxygen therapy should only continue to be prescribed if an improvement in breathlessness following therapy has been documented
    • when indicated, short-burst oxygen should be provided from cylinders

  • non-invasive ventilation (NIV)
    • adequately treated patients with chronic hypercapnic respiratory failure who have required assisted ventilation (whether invasive or non-invasive) during an exacerbation or who are hypercapnic or acidotic on LTOT should be referred to a specialist centre for consideration of long-term NIV

For more detailed guidance then see the full BTS guideline.

Reference:

  1. NICE (June 2010). Chronic obstructive pulmonary disease
  2. Hardinge M, Annandale J, Bourne S, et al.British Thoracic Society guidelines for home oxygenuse in adults.Thorax2015;70:i1-i43.