Home Oxygen Therapy for Adults with Chronic Lung Disease

Publication Date: August 30, 2020
Last Updated: January 19, 2024

Recommendations

Chronic Obstructive Pulmonary Disease

In adults with chronic obstructive pulmonary disease (COPD) who have severe chronic resting room air hypoxemia,* we recommend prescribing long-term oxygen therapy (LTOT) for at least 15 h/d. (S, M)
*Severe hypoxemia is defined as meeting either of the following criteria: 1) PaO2 ≤ 55 mm Hg (7.3 kPa) or oxygen saturation as measured by pulse oximetry (SpO2) ≤ 88%; 2) PaO2 = 56–59 mm Hg (7.5–7.9 kPa) or SpO2 = 89% plus one of the following: edema, hematocrit ≥ 55%, or P pulmonale on an ECG.
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In adults with COPD who have moderate chronic resting room air hypoxemia,* we suggest not prescribing LTOT. (C, L)
*Moderate hypoxemia is defined as an SpO2 of 89–93%.
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In adults with COPD who have severe exertional room air hypoxemia, we suggest prescribing ambulatory oxygen. (C, M)
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Interstitial Lung Disease

For adults with interstitial lung disease (ILD) who have severe chronic resting room air hypoxemia, we recommend prescribing LTOT for at least 15 h/d. (S, VL)
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For adults with ILD who have severe exertional room air hypoxemia, we suggest prescribing ambulatory oxygen. (C, L)
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Liquid Oxygen

In patients with chronic lung disease who are mobile outside of the home and require continuous oxygen flow rates of >3 L/min during exertion, we suggest prescribing portable liquid oxygen (LOX). (C, VL)
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Education and Safety

For patients prescribed home oxygen therapy, we recommend that the patient and their caregivers receive instruction and training on the use and maintenance of all oxygen equipment and education on oxygen safety, including smoking cessation, fire prevention, and tripping hazards. (, )
(best-practice statement)
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Recommendation Grading

Overview

Title

Home Oxygen Therapy for Adults with Chronic Lung Disease

Authoring Organization

American Thoracic Society

Publication Month/Year

August 30, 2020

Last Updated Month/Year

November 22, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Evidence-based guidelines are needed for effective delivery of home oxygen therapy to appropriate patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). These guidelines provide the basis for evidence-based use of home oxygen therapy in adults with COPD or ILD but also highlight the need for additional research to guide clinical practice.

Target Patient Population

Adults with chronic obstructive pulmonary disease (COPD), adults with interstitial lung disease (ILD)

PICO Questions

  1. Should long-term oxygen be prescribed for adults with COPD who have severe chronic resting room air hypoxemia?

  2. Should long-term oxygen be prescribed for adults with COPD who have moderate chronic resting room air hypoxemia?

  3. Should ambulatory oxygen be prescribed for adults with COPD who have severe exertional room air hypoxemia?

  4. Should long-term oxygen be prescribed for adults with ILD who have severe chronic resting room air hypoxemia?

  5. Should ambulatory oxygen be prescribed to adults with ILD who have severe exertional room air hypoxemia?

  6. Should portable LOX be provided for adults with chronic lung disease who are prescribed continuous oxygen flow rates of >3 L/min during exertion?

Inclusion Criteria

Male, Female, Adult

Health Care Settings

Ambulatory, Long term care

Intended Users

Nurse, nurse practitioner, physician, physician assistant, social worker

Scope

Assessment and screening

Diseases/Conditions (MeSH)

D017563 - Lung Diseases, Interstitial, D029424 - Pulmonary Disease, Chronic Obstructive

Keywords

hypoxemia, interstitial lung disease, chronic obstructive pulmonary disease (COPD), immobility, pulmonary disease, quality of life

Source Citation

Jacobs, S., Krishnan, J., Lederer, D., Ghazipura, M., Hossain, T., & Tan, A. et al. (2020). Home Oxygen Therapy for Adults with Chronic Lung Disease. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med, 202(10), e121-e141. doi: 10.1164/rccm.202009-3608st

Supplemental Methodology Resources

Data Supplement, Data Supplement, Data Supplement