From the Guidelines
Patients with severe COPD who have chronic hypoxemia (low blood oxygen levels) need continuous oxygen therapy, specifically those with a resting arterial oxygen saturation (PaO2) of ≤55 mmHg or an oxygen saturation (SpO2) of ≤88% on room air, as evidenced by the most recent and highest quality study 1.
Key Considerations
- Continuous oxygen therapy is recommended for COPD patients with severe resting hypoxemia, as it increases survival and improves quality of life 1.
- The typical prescription is for oxygen flow rates of 1-3 liters per minute, adjusted to maintain oxygen saturation above 90% 1.
- Continuous oxygen therapy should be used for at least 15 hours per day, but ideally 24 hours daily for maximum benefit 1.
Patient Selection
- COPD patients with PaO2 between 56-59 mmHg or SpO2 of 89% may also benefit from continuous oxygen therapy if they have evidence of right-sided heart failure, pulmonary hypertension, or polycythemia (elevated red blood cell count) 1.
- Patients with moderate hypoxemia (PaO2 , 69 mm Hg) may not benefit from long-term oxygen therapy, as evidenced by a trial that found no effect on survival 1.
Clinical Evidence
- A trial that compared long-term oxygen therapy with no oxygen therapy in patients with COPD with severe hypoxemia found that long-term oxygen therapy improved survival 1.
- The Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report recommends long-term oxygen therapy for patients with severe resting hypoxemia 1.
- The British Thoracic Society guidelines for home oxygen use in adults provide detailed evidence-based guidance for the use of home oxygen for patients with COPD and other long-term respiratory illnesses 1.
From the Research
COPD and Oxygen Therapy
- Patients with severe hypoxemia and COPD may require continuous oxygen therapy to improve mortality rates 2
- The Global Initiative for Chronic Obstructive Lung Disease assigns patients with COPD into four groups based on the degree of airflow restriction, symptom score, and number of exacerbations in one year 2
- Patients in group D are at high risk of exacerbations and may require continuous oxygen therapy, as they have severe airflow restriction and a high number of exacerbations 2
Characteristics of Patients Requiring Continuous Oxygen Therapy
- Patients with severe COPD, characterized by a postbronchodilator forced expiratory volume in one second/forced vital capacity ratio of less than 0.70, may require continuous oxygen therapy 2
- Patients with a low body mass index (BMI < 21 kg/m2) may have lower values of forced expiratory volume in one second (FEV1) and higher St. George's Respiratory Questionnaire (SGRQ) scores, indicating a poorer quality of life 3
Treatment Options for COPD
- Treatment for COPD includes medication, rehabilitation programs, and oxygen therapy, aimed at relieving symptoms and improving lung function and exercise tolerance 2, 3
- Inhaled corticosteroids (ICS) may be used in combination with long-acting β-agonist (LABA) bronchodilators to reduce severe exacerbations, but their use is limited by methodological problems and potential adverse effects 4