Provision of oxygen at homeBMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7163.935 (Published 03 October 1998) Cite this as: BMJ 1998;317:935
- P J Rees,
- F Dudley
Before patients in the United Kingdom are given long term oxygen therapy at home they must have arterial blood gas analysis, which is done at a hospital laboratory. The assessment should be supervised by a respiratory physician. In England and Wales this conflicts with the need for home oxygen to be prescribed by the patient's general practitioner. In Scotland arrangements are made by the respiratory specialist. Close liaison between general practice and hospital is necessary to ensure appropriate care for the patient. Often this is best organised by respiratory specialist nurses and practice nurses.
The assessments should be made with the patient in a stable state on optimal treatment and must be confirmed by a second assessment at least three weeks later. Several studies show that results from a single estimation are not always confirmed by a repeat analysis 4-12 weeks later. Although the UK criteria specify an arterial carbon dioxide pressure (PaCO2) >6 kPa for treatment, it is accepted that patients with a lower PaCO2 should have the same treatment. Criteria in other countries differ slightly.
The aim of long term oxygen therapy is to maintain arterial oxygen pressure (PaO2) at 9.3-12 kPa. This is usually achieved by a flow rate of 1-3 l/min. Ideally the PaO2 should be over 10.7 kPa to allow for falls during exercise, eating, sleeping, etc.
Prescription of long term oxygen in chronic obstructive pulmonary disease
Make sure other treatment is optimal
Assess patient for suitability (smoking, compliance)
Measure blood gas concentrations with patient in a stable state
Repeat measurements 3-4 weeks later
Arrange home oxygen if appropriate
Follow up for problems and compliance (preferably respiratory nurse visiting home)
Repeat blood gas measurements at 6-12 months
Most doctors would not prescribe home oxygen for people who continue to smoke. The evidence of …
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