[Long-term home oxygen therapy: who? with what? how expensive?].

Since 1981 long-term oxygen therapy (LTOT) has become an important procedure for the rehabilitation of patients with chronic respiratory insufficiency in Switzerland too. As a result of long-term clinical experience as well as technical progress, there is, however, increasing need for an updated reassessment of guidelines and standardized management respectively: the indications for LTOT-so far restricted to patients with COPD-are extended to patients with pulmonary diseases other than COPD associated with chronic hypoxemia (pO2 < 7.3 kPa) provided there is enough evidence of clinical benefit. Another important aspect of LTOT focuses on the appropriate application of different oxygen sources. Oxygen concentrators are still accepted to be the most economic domiciliary source. For short-term outdoor activities, small portable cylinders in combination with an oxygen conserving system should be used. However, in regular mobile oxygen therapy liquid oxygen is the best choice, generally consisting of a domiciliary reservoir and portable canisters. Delivery of oxygen through a transtracheal catheter is superior to nasal cannula because of lower oxygen consumption, decreased breathing work and improved compliance respectively. To organize and follow-up LTOT in Switzerland, a very efficient concept was introduced many years ago which is characterized by economical cooperation between physicians, insurances, technical suppliers and social providers. Today more than 3000 patients-corresponding to 38/100,000 inhabitants-benefit from LTOT. Future perspectives should target an earlier start to continuous as well as mobile LTOT, in order to improve rehabilitation in still active conditions instead of merely palliating the terminal stages.