New thoughts on long term domiciliary oxygen therapy.

The establishment of long term oxygen therapy (LTOT) in the patients' home for chronic respiratory failure associated with obstructive airways disease, is reviewed. The numbers of patients treated in different countries varies widely due to the acceptance of additional physiological criteria to basic measurements of arterial blood gases. The inclusion of these additional criteria has not yet been shown to result in prolonged survival or confer other clinical benefit. Further research studies should be undertaken before they are added to therapeutic guidelines. The selection of patients for home care is still the most difficult problem. It is probably best achieved by a panel of experts to include the local General Practitioner. The most cost effective oxygen administration system is still the oxygen concentrator. Longer term follow up of LTOT has demonstrated a limited survival benefit of approximately five years. It seems that hypoxaemia is being adequately treated but airway disease continues to increase and is eventually responsible for the death of the patient. It was once hoped that oxygen treatment would arrest progress of the disease. As this is not so, further treatments must be sought in addition to oxygen which will deal with progressive airways obstruction. There is a continuing need for research and audit of oxygen therapy particularly in the home environment.