Clark Kristopher P, Degenholtz Howard B, Lindell Kathleen O, Kass Daniel J
Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh-UPMC.
Division of Pulmonary, Critical Care, and Sleep Medicine, State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York.
Ann Am Thorac Soc. 2023 Nov;20(11):1541-1549. doi: 10.1513/AnnalsATS.202304-391CME.
Patients with interstitial lung diseases (ILD) often have hypoxemia at rest and/or with exertion, for which supplemental oxygen is commonly prescribed. The number of patients with ILD who require supplemental oxygen is unknown, although estimates suggest it could be as much as 40%; many of these patients may require high-flow support (>4 L/min). Despite its frequent use, there is limited evidence for the impact of supplemental oxygen on clinical outcomes in ILD, with recommendations for its use primarily based on older studies in patients with chronic obstructive pulmonary disease. Oxygen use in ILD is rarely included as an outcome in clinical trials. Available evidence suggests that supplemental oxygen in ILD may improve quality of life and some exercise parameters in patients whose hypoxemia is a limiting factor; however, oxygen therapy also places new burdens and barriers on some patients that may counter its beneficial effects. The cost of supplemental oxygen in ILD is also unknown but likely represents a significant portion of overall healthcare costs in these patients. Current Centers for Medicare and Medicaid reimbursement policies provide only a modest increase in payment for high oxygen flows, which may negatively impact access to oxygen services and equipment for some patients with ILD. Future studies should examine clinical and quality-of-life outcomes for oxygen use in ILD. In the meantime, given the current limited evidence for supplemental oxygen and considering cost factors and other barriers, providers should take a patient-focused approach when considering supplemental oxygen prescriptions in patients with ILD.
间质性肺疾病（ILD）患者在静息和/或运动时常常存在低氧血症，对此通常会开具补充氧气的处方。尽管据估计，需要补充氧气的ILD患者数量可能高达40%，但具体数字尚不清楚；其中许多患者可能需要高流量支持（>4升/分钟）。尽管补充氧气被频繁使用，但关于其对ILD临床结局影响的证据有限，其使用建议主要基于对慢性阻塞性肺疾病患者的早期研究。在临床试验中，很少将ILD患者使用氧气作为一项结局指标。现有证据表明，对于低氧血症成为限制因素的ILD患者，补充氧气可能会改善其生活质量和一些运动参数；然而，氧疗也给一些患者带来了新的负担和障碍，可能抵消其有益效果。ILD患者补充氧气的费用也不清楚，但很可能占这些患者总体医疗费用的很大一部分。目前医疗保险和医疗补助中心的报销政策仅适度提高了对高流量氧气的支付，这可能会对一些ILD患者获得氧气服务和设备产生负面影响。未来的研究应考察ILD患者使用氧气的临床和生活质量结局。与此同时，鉴于目前补充氧气的证据有限，并考虑到成本因素和其他障碍，医疗服务提供者在考虑为ILD患者开具补充氧气处方时，应采取以患者为中心的方法。
