REVIEW ARTICLE
THE ROLE OF GENERAL PRACTITIONERS IN HOME OXYGEN THERAPY
INDICATIONS FOR HOME OXYGEN THERAPY
There are many medical conditions which may benefit from home oxygen therapy. The British Thoracic Society has published a guideline for the use of home oxygen therapy5 (Box 1). Some of these conditions seen in primary care may be possible in the primary care setting.
HOME OXYGEN THERAPY FOR CHRONIC HYPOXAEMIA AND BREATHLESSNESS
The signs and symptoms of hypoxaemia are not specific; often they are present only when the condition is severe. Hypoxaemia adversely affects function and increases risk of death.7 Correction of this condition is the only treatment documented to improve survival in patients with COPD.8
Breathlessness is a complex experience of the body and the mind. It is a multi-systemic disorder with many accompanying subtle neuro-hormonal abnormalities and alterations in skeletal and respiratory muscle structure and function. The experience of breathlessness is likely to be modified both by previous experience of the sensation and by pathways from different areas in the central nervous system. Patients with similar disease can have breathlessness of widely different severity.9
Hypoxaemia itself does not cause breathlessness. Not all breathlessness can be relieved with oxygen therapy. Therefore breathlessness alone is not an indication for oxygen supplementation. However oxygen therapy may reduce breathlessness in hypoxaemic patients during exercise by decreasing ventilatory requirements and thereby reducing the work of breathing.7
Box 1. Indications for home oxygen therapy5
Long Term Oxygen Therapy
Chronic hypoxaemia in:
Chronic obstructive pulmonary disease
Severe chronic asthma
Diffuse interstitial lung disease
Cystic fibrosis
Bronchiectasis
Widespread pulmonary neoplasm
Pediatric bronchopulmonary dysplasia (BPD)
Pulmonary hypertension
Recurring congestive heart failure due to chronic cor pulmonale
Nocturnal hypoventilation (With continuous positive airway pressure, CPAP)
Obesity
Neuromuscular / spinal / chest wall disease
Obstructive sleep apnoea
Palliative use
Pulmonary malignancy
Short Burst Oxygen Therapy (SBOT)
SBOT has traditionally been used for:
Pre-oxygenation before exercise
Breathlessness during recovery from exercise
Control of breathlessness at rest
Used in palliative care
Used after an exacerbation of COPD to bridge the time to full LTOT assessment
Ambulatory oxygen therapy
Chronic hypoxaemia who are on LTOT and who need to leave the home on regular basis. Without chronic hypoxaemia, evidence of exercise oxygen de-saturation, improvement in exercise capacity and / or less breathlessness with ambulatory oxygen therapy.
