What are the main indications for home oxygen therapy?

Main Indications for Home Oxygen Therapy

Home oxygen therapy is primarily indicated for patients with chronic hypoxemia, specifically those with a resting PaO2 ≤7.3 kPa (55 mmHg) or SpO2 ≤88%, as well as those with PaO2 ≤8 kPa (60 mmHg) who have evidence of end-organ damage such as peripheral edema, polycythemia, or pulmonary hypertension. 1

Disease-Specific Indications

Chronic Obstructive Pulmonary Disease (COPD)

• Severe resting hypoxemia: PaO2 ≤7.3 kPa (55 mmHg) or SpO2 ≤88% 1, 2
• Moderate hypoxemia: PaO2 ≤8 kPa (60 mmHg) with evidence of:
  • Peripheral edema
  • Polycythemia (hematocrit ≥55%)
  • Pulmonary hypertension 1
• Patients with resting hypercapnia who fulfill other criteria for LTOT 1

Interstitial Lung Disease (ILD)

• Severe resting hypoxemia: PaO2 ≤7.3 kPa (55 mmHg) 1
• Moderate hypoxemia: PaO2 ≤8 kPa (60 mmHg) with evidence of end-organ damage 1
• Patients with mild chronic hypoxemia and either dyspnea on exertion or desaturation during sleep or exertion 1

Cystic Fibrosis (CF)

• Severe chronic hypoxemia 1
• PaO2 ≤7.3 kPa (55 mmHg) 1
• PaO2 ≤8 kPa (60 mmHg) with evidence of peripheral edema, polycythemia, or pulmonary hypertension 1
• Mild chronic hypoxemia with dyspnea on exertion 1

Pulmonary Hypertension

• Without congenital heart disease: PaO2 ≤8 kPa (60 mmHg) 1
• With congenital heart disease: Requires consultation with pediatric pulmonologist or cardiologist with expertise in pulmonary hypertension management 1

Neuromuscular or Chest Wall Disorders

• Non-invasive ventilation (NIV) is first-line treatment for type 2 respiratory failure
• Additional oxygen therapy for hypoxemia not corrected by NIV 1

Advanced Cardiac Failure

• PaO2 ≤7.3 kPa (55 mmHg) 1
• PaO2 ≤8 kPa (60 mmHg) with peripheral edema, polycythemia, or evidence of pulmonary hypertension 1

Sleep-Disordered Breathing

• Severe nocturnal hypoxemia in patients who cannot tolerate positive airway pressure therapy or are awaiting surgical treatment 1

Sickle Cell Disease

• Severe chronic hypoxemia 1

Clinical Criteria for Home Oxygen Therapy

1. Timing of Assessment:

   • Patients should be clinically stable for at least 3 weeks 2
   • Assessment should not be performed during acute exacerbations 2

2. Confirmation Requirements:

   • Two separate arterial blood gas measurements at least 3 weeks apart showing consistent hypoxemia 2
   • For pediatric patients, a low SpO2 for a duration of 2 weeks is sufficient evidence for chronic hypoxemia if clinically stable 1

3. Duration of Therapy:

   • Minimum of 15 hours per day, including sleep periods 2
   • Continuous administration shows greater survival benefit than intermittent use 2

4. Flow Rate Goals:

   • Maintain SpO2 >90% without worsening respiratory acidosis 2
   • Typical flow rates: 1.5-2.5 L/min via nasal cannula 2
   • Annual reassessment of flow requirements recommended 2

Special Considerations

Ambulatory Oxygen

• Indicated for patients with significant desaturation during exercise to improve exercise tolerance and dyspnea 2, 3
• Particularly important for patients who are mobile outside the home 4

Palliative Oxygen Therapy

• For patients with ILD or other conditions experiencing severe breathlessness 1
• Used in end-stage cardiorespiratory disease and terminal illness 1

Safety Concerns

• Current smoking is a contraindication due to fire hazard 2
• Water-based products should be used on hands and face while using oxygen 1
• Local fire service should be informed about patients using home oxygen 1

Benefits of Home Oxygen Therapy

• Improved survival in COPD patients with severe hypoxemia 5, 4
• Decreased hospitalizations 6
• Improved physical growth and neurological development in pediatric patients 6
• Enhanced exercise tolerance and quality of sleep 6
• Prevention of pulmonary hypertension/cor pulmonale 6
• Improved pulmonary hemodynamics 1

Home oxygen therapy is a critical intervention for patients with chronic hypoxemia across various disease states. The evidence is strongest for COPD, but similar criteria are applied to other conditions with appropriate disease-specific considerations.