A new clinical practice guideline on home oxygen therapy which addresses long-term and ambulatory oxygen therapy for adults has been released by the American Thoracic Society.

Released yesterday (17th) the guideline looks at ambulatory oxygen therapy for adults with chronic obstructive pulmonary disease and interstitial lung dieses and includes a comprehensive review of the evidence of any oxygen guideline. 

The new guideline was borne out of the 2017 ATS workshop on Optimising Home Oxygen Therapy data, which “identified the lack of evidence-based clinical practice guidelines for appropriate use of home oxygen as a critical gap,” wrote the guideline panel.

Susan Jacobs, Co-Chair of the Guideline Committee, said, “Oxygen is a common, yet burdensome, equipment-laden therapy, so if we are going to prescribe it, there should be enough evidence that we can tell our patients what they should expect in terms of improving their symptoms, and the quality and quantity of their lives.”

The multidisciplinary panel used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to formulate the below recommendations:

COPD Recommendations

  • In adults with COPD who have severe chronic resting room air hypoxemia, we recommend prescribing Long Term Oxygen Therapy (LTOT) at least 15 hours per day (strong recommendation, moderate quality evidence).
  • In adults with COPD who have moderate chronic resting room air hypoxemia, we suggest not prescribing LTOT (conditional recommendation, low quality evidence).
  • In adults with COPD who have severe exertional room air hypoxemia we suggest prescribing ambulatory oxygen (conditional recommendation, moderate quality evidence).

ILD Recommendations

  • For adults with ILD who have severe chronic resting room air hypoxemia we recommend prescribing LTOT at least 15 hours per day (strong recommendation, very low-quality evidence).
  • For adults with ILD who have severe exertional room air hypoxemia we suggest prescribing ambulatory oxygen (conditional recommendation, low quality evidence).

Liquid Oxygen Recommendation

  • In patients with chronic lung disease who are mobile outside of the home and require continuous oxygen flow rates of >3L/minute during exertion, we suggest prescribing portable liquid oxygen (conditional recommendation, very low-quality evidence).