ATS issues new guidance on home oxygen therapy for adults with COPD, ILD

A new guideline issued by the American Thoracic Society addresses long-term and ambulatory home oxygen therapy use in patients with COPD and interstitial lung disease.

The new guideline was borne out of a 2017 ATS workshop on Optimizing Home Oxygen Therapy data, according to an ATS press release. This workshop “identified the lack of evidence-based clinical practice guidelines for appropriate use of home oxygen as a critical gap,” the authors wrote in the American Journal of Respiratory and Critical Care Medicine.

Further rationale for new guidance was based on “a summary of results from an online survey of almost 2,000 oxygen users in the U.S. describing the multiple problems they had in accessing and using their oxygen,” Susan S. Jacobs, MS, RN, co-chair of the guideline committee and research nurse manager in pulmonary, allergy and critical care medicine at Stanford University, said in the release.

“Our aim was to conduct a rigorous and systematic review and develop clinical guidelines targeting health care providers who care for adults living with chronic lung disease who need oxygen in the community outside of inpatient and emergency settings,” Jacobs and colleagues wrote. “In applying these guidelines, clinicians should use an interactive, shared decision-making approach to ensure oxygen prescriptions meet the needs of individual patients by considering physiology, lifestyle and treatment preferences.”

Recommendations

Recommendations were made using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Patients with COPD

Long-term oxygen therapy for at least 15 hours per day is recommended for adults with COPD and severe chronic resting room air hypoxemia; this is a strong recommendation with moderate quality evidence.

Long-term oxygen therapy is not recommended for adults with COPD and moderate chronic resting room air hypoxemia; this is a conditional recommendation with low quality evidence.

Ambulatory oxygen is recommended for adults with COPD and severe exertional room air hypoxemia; this is a conditional recommendation with moderate quality evidence.

Patients with ILD

Long-term oxygen therapy for at least 15 hours per day is recommended for adults with ILD and severe chronic resting room air hypoxemia; this is a strong recommendation with very low quality evidence.

Ambulatory oxygen is recommended for adults with ILD and severe exertional room air hypoxemia; this is a conditional recommendation with low quality evidence.

The guideline panel also addressed liquid oxygen. Portable liquid oxygen is recommended in patients with chronic lung disease who are mobile outside of the home and require continuous oxygen flow rates of at least 3L per minute during exertion; this is a conditional recommendation with very low quality evidence, according to the release.

For all patients who are prescribed home oxygen therapy, the ATS recommends that the patient and their caregivers receive educational instruction and training on the use and maintenance of all required oxygen equipment and receive education on oxygen safety, including smoking cessation, fire prevention and tripping hazards.

Further recommendations and details can be found in the full guideline.

‘Need for guidance is high’

It is estimated that more than 1 million adults with chronic lung disease in the U.S. are prescribed long-term oxygen therapy.

“Our systematic review reveals that the quality and quantity of clinical trial evidence is low, thereby leaving significant gaps in available data regarding the prescription of supplemental oxygen,” the authors wrote. “The need for guidance is high; the prescription of supplemental oxygen is common. The recommendations in this document reflect an integration of current evidence and clinical experience by a multidisciplinary expert panel.”