Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
Centre for Research Ethics and Bioethics (CRB), Uppsala University, Uppsala, Sweden.
Eur Respir Rev. 2024 Jan 31;33(171). doi: 10.1183/16000617.0194-2023.
Home oxygen therapy (HOT) improves survival in patients with hypoxaemic chronic respiratory disease. Most patients evaluated for HOT are former or active smokers. Oxygen accelerates combustion and smoking may increase the risk of burn injuries and fire hazards; therefore, it is considered a contraindication for HOT in many countries. However, there is variability in the practices and policies regarding this matter. This multidisciplinary Swedish taskforce aimed to review the potential benefits and risks of smoking in relation to HOT, including medical, practical, legal and ethical considerations.
The taskforce of the Swedish Respiratory Society comprises 15 members across respiratory medicine, nursing, medical law and ethics. HOT effectiveness and adverse risks related to smoking, as well as practical, legal and ethical considerations, were reviewed, resulting in five general questions and four PICO (population-intervention-comparator-outcome) questions. The strength of each recommendation was rated according to the GRADE (grading of recommendation assessment, development and evaluation) methodology.
General questions about the practical, legal and ethical aspects of HOT were discussed and summarised in the document. The PICO questions resulted in recommendations about assessment, management and follow-up of smoking when considering HOT, if HOT should be offered to people that meet the eligibility criteria but who continue to smoke, if a specific length of time of smoking cessation should be considered before assessing eligibility for HOT, and identification of areas for further research.
Multiple factors need to be considered in the benefit/risk evaluation of HOT in active smokers. A systematic approach is suggested to guide healthcare professionals in evaluating HOT in relation to smoking.
家庭氧疗（HOT）可改善低氧血症性慢性呼吸系统疾病患者的生存率。大多数接受 HOT 评估的患者都是曾经或正在吸烟的患者。氧气会加速燃烧，而吸烟可能会增加烧伤和火灾危险的风险；因此，在许多国家，它被认为是 HOT 的禁忌症。然而，在这方面，实践和政策存在差异。这个多学科的瑞典工作组旨在审查吸烟与 HOT 相关的潜在益处和风险，包括医学、实际、法律和伦理方面的考虑。
瑞典呼吸学会的工作组由 15 名成员组成，涵盖呼吸医学、护理、医疗法律和伦理等领域。审查了 HOT 有效性和与吸烟相关的不良风险，以及实际、法律和伦理方面的考虑，得出了五个一般问题和四个 PICO（人群-干预-比较-结果）问题。根据 GRADE（推荐评估、制定和评估分级）方法对每项建议的强度进行了评级。
文件中讨论并总结了有关 HOT 的实际、法律和伦理方面的一般问题。PICO 问题导致了有关在考虑 HOT 时对吸烟进行评估、管理和随访的建议，如果符合资格标准但仍在吸烟的人应否获得 HOT，如果在评估 HOT 资格之前应考虑特定的戒烟时间，以及确定进一步研究的领域。
在评估吸烟者 HOT 的获益/风险时需要考虑多个因素。建议采用系统的方法来指导医疗保健专业人员评估与吸烟有关的 HOT。
