Oxygen and inhalersBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7557.34 (Published 29 June 2006) Cite this as: BMJ 2006;333:34
All rapid responses
Myths on long term oxygen therapy (LTOT) are long lived. “Ensuring
that patients have stopped smoking” before prescribing oxygen might harm
the honest smokers with COPD. In the ABC of chronic obstructive pulmonary
disease Currie1 does not give the evidence for this advice.
The hard evidence for LTOT rests on two key studies2;3 The evidence
becomes visible only if you read one key reference4.
The study population in the key studies was composed of a mixture of
smokers and non-smokers. The precise fraction of smokers was not reported.
In a later Cochrane review5 on LTOT, not cited by Currie, smoking was not
mentioned as a contraindication to LTOT.
We got access to the key reference only with the help of one of the
original organisers of the NOTT study. It was a bit horrifying to learn
that denial of oxygen to smokers was not evidence based although
guidelines were followed.
We were in a situation where the dishonest smoker, denying smoking, got
his oxygen and the honest smoker, admitting smoking, did not.
An evidence based reason for denying smokers oxygen is the danger of fire.
The risk is real but the evidence is weak and based on case stories only.
During a pro and con meeting in our small community it became clear that
most oxygen prescribing doctors were familiar with one case of fire and
burns due to simultaneous smoking and use of oxygen. During the discussion
it became clear that it was probably the same patient that all had heard
It seems safe to conclude: Smokers should stop smoking. LTOT prolongs life
in a mixture of smokers and non smokers. If oxygen is denied the reason
should be equally transparent to the patient and the doctors themselves.
Guidelines should be changed.
(1) Currie GP, Douglas JG. Oxygen and inhalers. BMJ 2006;
(2) Nocturnal Oxygen Therapy Trial Group. Continuous or nocturnal oxygen
therapy in hypoxemic chronic obstructive lung disease: a clinical trial.
Ann Intern Med 1980; 93(3):391-398.
(3) Medical Research Council Working Party. Long term domiciliary oxygen
therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis
and emphysema. Lancet 1981; 1(8222):681-686.
(4)"National Heart Lung and Blood Institute. Division of Lung Disease.
Protocol for Noc-turnal Oxygen therapy Collaborative Programme. Bethesda:
National Institute of Health; 1978.
(5)Cranston JM, Crockett AJ, Moss JR, Alpers JH. Domiciliary oxygen for
chronic ob-structive pulmonary disease. The Cochrane Database of
Systematic Reviews 2005, Issue 4. Art. No.: CD001744. DOI:
Competing interests: No competing interests