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Assessments for oxygen therapy in COPD: are we under correcting arterial oxygen tensions?

¹ Dept of Thoracic and HIV Medicine, Royal Free and UCL Medical School, Royal Free Hospital NHS Trust, ² Dept of Thoracic Medicine/Allergy, Homerton University Hospital NHS Foundation Trust and ³ Dept Primary Care and Population Sciences, Royal Free and UCL Medical School, London, UK

CORRESPONDENCE: K. Dheda, Dept of Respiratory and HIV Medicine, Royal Free Hospital, Pond Street, London, UK. Fax: 44 2076368175. E-mail: k.dheda@ucl.ac.uk

Keywords: Chronic obstructive pulmonary disease, concentrator, long-term oxygen therapy, oxygen assessment

Received: July 29, 2004
Accepted August 3, 2004

There is little data about the use of different oxygen sources during assessment for long-term oxygen therapy (LTOT) and how this impacts upon blood oxygen tensions and prescribed flow rates.

Patients with chronic obstructive pulmonary disease (COPD), n=30, had assessments for LTOT using both an oxygen-concentrator and piped hospital oxygen (wall-oxygen) as supply sources. In addition, a random survey of 64 hospitals was conducted to determine what source of oxygen supply was used during assessments.

Wall-oxygen was used by 89% of hospitals to perform assessments. During assessments, the median oxygen flow required to achieve an arterial oxygen tension (P_a,O2) >8 kPa was significantly greater for an oxygen-concentrator than for wall-oxygen, with a median difference (range) in flow of 1 (0–3) L. This difference was most likely in those with an forced expiratory volume <30% of predicted. At an oxygen flow of 1 L·min^–1, the mean P_a,O2 using an oxygen-concentrator was significantly lower than that of the wall-oxygen value, with a difference of 1.32±1.19 kPa (mean±SD).

The common practice of using wall-oxygen to perform assessments significantly underestimates the required oxygen-concentrator flow rate. This may have implications for the long-term effect of domiciliary oxygen therapy.

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