Long-Term Oxygen Therapy (or Home Oxygen Therapy) for COPD: The Present State and Future Problems

Abstract

The purpose of long-term oxygen therapy, which has been called home oxygen therapy (HOT) in Japan, for chronic respiratory failure is to prevent severe hypoxemia and the development of pulmonary hypertension, and improve mortality. The recommendations for HOT are based on the MRC and NOTT studies performed over 30 years ago. The indications for HOT based on the two studies may not necessarily be representative of today's COPD patients. There is no concrete evidence concerning the effects of HOT on the prevention of pulmonary hypertension, improvement of ADL, QOL, and physical activity, and little beneficial evidence for patients with mild to moderate hypoxemia at rest or daytime, except for exercise-induced severe hypoxemia, nocturnal oxygen desaturation, comorbidities such as cardio-and cerebrovascular comorbidities, or severe breathlessness on exertion. Further examination will be necessary in the future during the development of a new oxygen supplying device. At the time of HOT prescription, we let the patients and their family understand the need for HOT and educate them in the directions for use. We should explain and guide them in how to use the oxygen supply apparatus safely, the confirmation of the prescribed oxygen flow, the management and maintenance of the oxygen supplying device, communication for a disaster and emergency, concerns about daily life, the prevention and correspondence of the exacerbation, the use of the welfare system, and medical expenses.