Ep 63 – Domiciliary oxygen guidance

Oxygen is essential for our survival and is a powerful medical drug. Treatment with oxygen increases blood oxygen levels and helps to reduce cardiovascular workload. In this podcast, Dr Roger Henderson looks at how oxygen can be given in a home environment, the reasons it may be required and the different types of delivery systems available. He also looks at practical issues such as flying when requiring oxygen, smoking near oxygen supplies, how to arrange an emergency supply of oxygen for home use and which types of masks and nasal cannulae to use.

Key references

1. NICE, Clinical Knowledge Summaries. Chronic Obstructive Pulmonary Disease. November 2021.
2. Hardinge M, et al. Thorax. 2015 Jun;70(1):i1-43. doi: 10.1136/thoraxjnl-2015-206865.
3. Hardavella G, et al. Breathe. 2019 Sep;15(3):e108-e116. doi: 10.1183/20734735.0204-2019.
4. O'Driscoll BR, et al. BMJ Open Respir Res. 2017 May;4(1):e000170. doi: 10.1136/bmjresp-2016-000170.
5. Ahmedzai S, et al. Thorax. 2011 Sep;66(1):i1-30. doi: 10.1136/thoraxjnl-2011-200295.

Key take-home points

• NICE recommends home oxygen assessment for all patients with very severe airflow obstruction.
• Using oxygen for at least 15 hours a day does appear to improve survival in patients with severe chronic obstructive pulmonary disease (COPD).
• The term “oxygen devices” refers to oxygen concentrators, compressed gas cylinders and liquid oxygen.
• The term “delivery systems” refers to high- or low-flow oxygen.
• The usual methods of delivering portable oxygen are via a portable and lightweight cylinder, home fill cylinders or liquid oxygen cylinders.
• Oxygen is not indicated in people who are not motivated to use it for the required number of hours each day, or who maintain oxygen levels greater than 91% in air.
• The risks of prescribing oxygen to smokers should be considered on a case-by-case basis and long-term oxygen should not be offered to smokers who continue to smoke despite being offered smoking cessation interventions.
• E-cigarettes and chargers should not be used in the vicinity of home oxygen.
• If oxygen is required urgently before specialist appraisal, this can be ordered on a home oxygen order form (HOOF) Part A, with a home oxygen consent form (HOCF) being completed for every patient.
• Most patients – and all with COPD – should initially be given oxygen via a Venturi 24% mask at a flow rate of 2–3 L/min, a Venturi 28% mask at 4–6 L/min, or via nasal cannulae at 1–2 L/min.
• If in-flight oxygen is required, this is usually supplied by the airline and must always be booked in advance.