Clinical Review ABC of oxygen

Provision of oxygen at home

BMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7163.935 (Published 03 October 1998) Cite this as: BMJ 1998;317:935
  1. P J Rees,
  2. 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.

    Patient using oxygen at home

    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.

    View this table:

    Criteria for long term oxygen in different countries

    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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