What are the indications for an oxygen concentrator in patients with Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

Oxygen concentrators are indicated for COPD patients who demonstrate chronic hypoxemia, specifically when their resting arterial oxygen saturation (SpO2) is ≤88% or their partial pressure of arterial oxygen (PaO2) is ≤55 mmHg, as recommended by the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society 1.

Key Indications for Oxygen Concentrators in COPD Patients

• Resting arterial oxygen saturation (SpO2) ≤88%
• Partial pressure of arterial oxygen (PaO2) ≤55 mmHg
• Evidence of cor pulmonale, right heart failure, or polycythemia (hematocrit >55%) with SpO2 89% or PaO2 56-59 mmHg

Long-Term Oxygen Therapy

• Should be used for at least 15 hours per day, with optimal benefit achieved at 24 hours daily
• Prescribed flow rate should maintain SpO2 ≥90% or PaO2 ≥60 mmHg
• Oxygen requirements may increase during sleep, exercise, or COPD exacerbations, so titration in these conditions is important

Benefits of Oxygen Therapy

• Reduces hypoxic pulmonary vasoconstriction
• Decreases pulmonary artery pressure
• Reduces the workload on the right ventricle
• Improves oxygen delivery to tissues
• Leads to improved exercise tolerance, cognitive function, quality of life, and reduced hospitalizations
• Long-term oxygen therapy is the only intervention proven to extend survival in hypoxemic COPD patients, with benefits seen after 6-12 months of consistent use, as supported by studies such as those referenced in 1 and 1.

Recent Guidelines

• The 2017 BTS guideline for oxygen use in adults in healthcare and emergency settings recommends targeting a saturation of 88–92% for COPD patients 1.
• The 2017 official ERS/ATS clinical practice guidelines for noninvasive ventilation for acute respiratory failure also support targeting a saturation range of 88–92% for COPD patients 1.

From the Research

Indications for Oxygen Concentrator in COPD Patients

The following are indications for an oxygen concentrator in patients with Chronic Obstructive Pulmonary Disease (COPD):

• Severe resting hypoxemia, defined as room air oxygen saturation (SpO(2)) ≤88% 2
• Hypoxemic COPD patients who require long-term oxygen therapy 2
• Patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) who have an oxygen saturation below 88% 3
• Patients who require supplemental oxygen therapy and have a target oxygen saturation of 88% to 92% 3

Benefits and Considerations

The use of oxygen concentrators in COPD patients has several benefits, including:

• Improved quality of life and exercise tolerance 4, 5
• Increased portability and reduced encumbrance compared to traditional oxygen systems 4
• Ability to maintain SaO2 levels during exercise, although this may vary depending on the device used 6 However, it is also important to consider the potential risks and limitations, such as:
• Oxygen-induced hypercapnia, which can occur in patients with COPD and other chronic lung diseases 3
• Noise disturbance and other device-related issues 5
• Variability in device performance and ability to maintain SaO2 levels during exercise 6

Patient Selection and Device Choice

The choice of oxygen concentrator and patient selection should be based on individual patient needs and characteristics, including:

• Severity of hypoxemia and oxygen requirements 2, 3
• Exercise tolerance and ability to maintain SaO2 levels during activity 6
• Patient preference and ability to use the device 5
• Presence of other medical conditions or comorbidities that may affect oxygen therapy 3