THE ROLE OF GENERAL PRACTITIONERS IN HOME OXYGEN THERAPY
SB Khoo FRACGP
Penang Medical College.
Address for correspondence: Dr Khoo Siew Beng, Department of Clinical Skills, Penang Medical College, No 4, Sepoy Lines Road, Penang 10450, Malaysia. Tel: 604-2263451, Fax: 604-2284285, E-mail: firstname.lastname@example.org
Conflict of interest: none
Recommendation of oxygen therapy must include clear indication and benefits of its use, appropriate prescription, vigilant monitoring and appropriate methods of delivery. Home oxygen therapy is expensive, inconvenient and cumbersome; it should be recommended only if benefits outweigh the disadvantages and adverse effects of oxygen. GPs play an important supportive and supervisory role in the use of long-term oxygen therapy (LTOT) to improve mortality of patients with chronic hypoxaemia. Prescription of short burst oxygen therapy (SBOT) for palliation of breathlessness is without clear evidence of its efficacy. GPs can prescribe SBOT when other secondary causes of breathlessness are excluded or treated, when breathlessness is not relieved by other treatments and if an improvement can be documented in patients.
Keywords: Long term oxygen therapy, short burst oxygen therapy, chronic hypoxaemia, breathlessness, palliationKhoo SB. The role of general practitioners in home oxygen therapy. Malaysian Family Physician. 2007;2(2):58-63
Oxygen is a powerful symbol of medical care that is probably more important than its actual therapeutic value in the relief of breathlessness.1 It is widely available and commonly prescribed by medical and paramedical staff but is often given without careful evaluation of its potential benefits and side effects. Like any drug therapy there must be clear indications for treatment with oxygen, appropriate prescription, vigilant monitoring and appropriate methods of delivery.2
Table 1. Terminology of home oxygen therapy
The following laboratory values, obtained while breathing ambient air:
|Long Term Oxygen Therapy (LTOT)||Provision of oxygen therapy for continuous use at home for patients with chronic hypoxaemia. The flow rate must be sufficient to raise the waking oxygen tension in adults to above 60mm Hg. It is usually given for at least 15 hours daily, to include nighttime.|
|Short Term Oxygen Therapy||Similar use as in LTOT but only for a brief period of 1-3 months during unstable clinical condition such as those following acute episodes of pneumonia or attacks of COPD.|
|Short Burst Oxygen Therapy (SBOT)||Intermittent use of supplemental oxygen at home usually for periods of about 10-20 minutes at a time to relieve breathlessness.|
|Ambulatory Oxygen Therapy||
Provision of oxygen therapy during exercise and activities of daily living.
Note: In the literature Long Term Oxygen Therapy (LTOT) is often used as a synonymous of Continuous Oxygen Therapy (COT) and Home Oxygen Therapy (HOT)
Home oxygen therapy is an effective but potentially expensive and inconvenient intervention. It should be prescribed only for patients in whom there is evidence of benefit, such as those whose disability relates to a chronic reduced arterial oxygen concentration (chronic hypoxaemia).3 In the absence of hypoxaemia, oxygen therapy is less likely to be useful except for cluster headache.3 Reasons for inadequate or inappropriate use of home oxygen therapy may be partly due to professional knowledge and behaviour.4
It is important to understand the terminology used in home oxygen therapy (Table 1 and Figure 1).
Figure 1. Terminology of home oxygen therapy5,6
(click here the chart to see an larger chart)