Current Issue - 2007, Volume 2 Number 2

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THE ROLE OF GENERAL PRACTITIONERS IN HOME OXYGEN THERAPY

Box 2. Adverse effects of oxygen therapy2

Restriction of mobility and activities
Cumbersome oxygen apparatus
Expensive, inconvenient
Impaired communication between patient and family
Induces anxiety, alters self image of patient
Psychological dependence
Prolonged hospitalization
Fire hazard
Reduce hypoxic respiratory drive
Difficult to withdraw oxygen therapy even if it is used appropriately
Humidifier noisy, bulky and often ineffective
Pulmonary oxygen toxicity

Box 3. Precautions15

  1. Stay at least 6 feet away from open flame or heat source.
  2. Do not store oxygen system near heat sources or open flame. Store in cool, well-ventilated area.
  3. Do not smoke. Post “No smoking” signs.
  4. Use correct regulator and pressure gauge. Do not change flow rate on your own.
  5. Oxygen is a drug and must be used as your doctor prescribed it.
  6. Before connecting regulator, open cylinder momentarily with valve pointing away, to remove any dust that may be in the outlet.
  7. Never use more than 50 feet of oxygen tubing – will dilute concentration of oxygen received.
  8. Be sure to have a functioning smoke detector and fire extinguisher in your home.
  9. Keep oxygen away from aerosol cans and sprays.
  10. Do not use cleaning products or other products containing grease or oils, petroleum jelly, alcohol or flammable liquids on or near oxygen system.
  11. Do not carry liquid oxygen in a backpack or enclosed space.
  12. Notify electrical company if you are using oxygen concentrator system so they can make your house priority during a power outage.
  13. Avoid skin contact when filling your portable liquid oxygen tank as frost build-up can cause injury.
  14. Always have backup tanks available and know how to use them.
  15. When cylinder is almost empty, close the valve and mark the cylinder as empty. Do not store full and empty cylinders together.

Prescription of SBOT for palliation of breathlessness

Oxygen therapy may be part of palliative care for patients with cancer, COPD and CHF but never a complete treatment in itself. In view of lack of evidence to support its use for episodic relief of breathlessness and the many adverse effects of oxygen therapy it should be used appropriately rather than universally.10 SBOT should only be prescribed when other causes of breathlessness are excluded, when breathlessness is not relieved by other treatments and if an improvement can be documented in patients.5 Considering the goal is to relieve the symptom of breathlessness regardless of hypoxaemia, a trial of oxygen therapy can be carried out when all other treatments fail.1

SBOT can be prescribed by GPs after a period of casual observation at home.Formal exercise testing may not be appropriate for assessment. Clinical judgment and consultation with the patient are the foundations of palliative care as relief of symptoms and improved quality of life are the central aim.10 Before oxygen therapy is prescribed simple test like visual analogue scale must show clear evidence of benefit.9 Frequent reassessment of treatment strategy is necessary as the symptoms may change quite rapidly in advanced cancer. Patients with cancer may experience rapid onset of breathlessness from previous good health, at a younger age. Some have double fear that death is imminent and that they will die gasping for breath.9

Breathlessness is not related to oxygen saturation or other respiratory measurements. Hence monitoring of oxygen saturation or arterial blood gases is not useful in assessing whether oxygen works.1 Patient’s report of symptom severity using visual analogue scale is the best measure.9 Oxygen is not indicated unless patients say it makes them feel better. It should not be continued unless there is clear benefit. While oxygen is easy to use, it is expensive and may be cumbersome and burdensome at home for some. Adverse effects of oxygen are tabulated in Table 4.2

CONCLUSION

GPs play a supportive role in the use of long-term and ambulatory oxygen therapy for chronic hypoxaemic conditions where LTOT has been proven to improve mortality and morbidity. Prescription of SBOT by GPs for symptomatic relief of breathlessness needs to be considered only after the exclusion and management of secondary causes of breathlessness, failure of optimal non-therapeutic and therapeutic interventions. Criteria for using SBOT is clear indication that the benefits of relieving breathlessness as expressed subjectively by the individual patient, outweighs the inconvenience and adverse effects of oxygen therapy.

References

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  2. Bateman NT, Leach RM. ABC of oxygen. Acute oxygen therapy. BMJ. 1998; 317:798-801 [PubMed] [Full text]
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  10. Booth S, Anderson H, Swannick M, et al. The use of oxygen in the palliation of breathlessness? A report of the expert working group of the Scientific Committee of the Association of Palliative Medicine. Respir Med. 2004;98(1):66-77 [PubMed] [Full text]
  11. Schwartzstsein RM, Lahive K, Pope A, et al. Cold facial stimulation reduces breathlessness induced in normal subjects. Am Rev Respir Dis. 1987;136(1):58-61 [PubMed]
  12. Liss HP, Grant BJ. The effect of nasal flow on breathlessness in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. 1988;137(6):1285-8 [PubMed]
  13. Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Report of the Medical Research Council Working Party. Lancet. 1981;1:681-6 [PubMed]
  14. Swinburn CR, Mould H, Stone TN, et al. Symptomatic benefit of supplemental oxygen in hypoxemic patients with chronic lung disease. Am Rev Respir Dis. 1991;143(5 Pt 1):913-5. [PubMed]
  15. Health information: Home Oxygen Therapy for COPD. Cleveland Clinic Health System, 2004 [Full text]

 

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