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1 Division of Respiratory Medicine, University of Toronto, West Park Hospital, Toronto, Canada. 2 Dept of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. 3 Pulmonary Dept, Scientific Institute of Gussago, Fondazione Salvatore Maugeri IRCCS, Gussago, Italy. 4 Dept of Pulmonary and Critical Care Medicine, St Elizabeth's Medical Centre, Tufts University, Boston, MA, USA. 5 Dept of Pneumologia, Hospital de la Santa Creu I de Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain. 6 Service de Pneumologie, Centre Hospitalo-Universitaire de Rouen, Rouen, France. 7 Laboratoire de Physiologie des Interactions, Service EFR, Hôpital Arnaud de Villeneuve, Montpellier, France. 8 Doencas do Aparelho Respiratorio, Hospital do Servidor Publico Estadual, Sao Paulo-SP, Brazil
CORRESPONDENCE: R.S. Goldstein, West Park Hospital, Respiratory Medicine, 82 Buttonwood Avenue, Toronto, Ontario, M6M 25J, Canada. Fax: 1 4162438947
Keywords: Chronic obstructive pulmonary disease, long-term oxygen therapy, prescription, survey
Received: January 3, 2001
Accepted April 30, 2001
While there is broad agreement about who should receive long-term oxygen therapy (LTOT), there is little information available on how clinicians should decide on the oxygen prescription itself, at rest, during sleep and during exercise. The authors describe the results of an international survey that was undertaken to compare how respirologists prescribed oxygen.
A questionnaire was sent to 100 respirologists in each of seven countries. The questionnaire identified whether resting flow rates were derived in a standard manner or by individualized patient testing. Test targets were ascertained for rest, exercise and sleep, as was the percentage of time that each test target had to reach for the test to be accepted.
The majority of respondents individualized the oxygen prescription at rest (81%). Resting arterial oxygen saturation (Sa,O2) was most commonly targeted at 90–91%. The approach to night prescription varied (p<0.001). Respirologists in Canada and the USA increased the resting Sa,O2 by 1–2 L·min–1 during sleep, while those in Spain used the resting (awake) flow for the night prescription (62%). Respirologists in the Netherlands, France, and Italy individualized the night prescription more frequently. Although oxygen during exercise was individualized in most countries (74%), significant differences remained among countries (p<0.001). The majority of respirologists (62%) aimed to achieve an Sa,O2 of 90–91% during exercise, while 70% of all respirologists tried to achieve the desired Sa,O2 for 90% of the test.
There were substantial differences among countries as to how the oxygen prescription was written. This survey highlights the need for multicentre studies that improve the effectiveness of long-term oxygen therapy utilization.
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