Long-term oxygen therapy (LTOT) is the most important treatment for chronic hypoxaemia, particularly in chronic obstructive pulmonary disease (COPD). The evidence supporting LTOT is still based on two > 25 year old studies (Ann Intern Med 1980;93:391; Lancet 1981;8222:681). Considering the effects but also the costs of LTOT, strict criteria (Am J Respir Crit Care Med 2006;174:373) are provided but the adherence to these criteria is variable. In this study we investigated the adherence to the criteria for LTOT in the area of Ferrara and Modena (Italy).
We selected a random sample of 191 patients referring to the Oxygen Service at the Hospitals in Ferrara and Modena (January 2005–December 2006). Data collection included: demographic characteristics, smoking history, cause of chronic respiratory failure (CRF), co-morbidities and evidence for cor pulmonale, pulmonary hypertension, resting PaO2 on air and/or pulse-oximetry (SatO2) on air, prescriptions details. We considered guidelines criteria as our references for the LTOT prescription (Am J Respir Crit Care Med 2006;174:373).
We reviewed the records of 191 patients (109 males) on LTOT. Out of 191 patients, 26 were smokers, 85 ex-smokers, 40 non-smokers, 40 data missing. The major cause of chronic hypoxaemia requesting LTOT was a pulmonary disease (154 out of 166 with fully available records). Among pulmonary diseases, the more frequent cause of LTOT was COPD (119/166, 71.7%). In COPD patients (119 out of 166), the most common were hypertension (56%), chronic heart failure (35%), other cardiovascular diseases (24%), and other various chronic diseases (64%). Adherence to LTOT prescription criteria was poor, i.e. 52.4%, and adherence to the recommendation of LTOT for ≥ 15h/day was provided in only 58.6%.
The study shows that patients prescribed LTOT have several chronic co-morbidities, and the adherence to LTOT is poor.
Considering the benefits but also the high costs of LTOT, adherence to guidelines should be monitored and enforced. The study was carried out in the University Research Program -Regione Emilia-Romagna 2007–2009-Study code number /2/2/2/8/.
Alessia Verduri, No Financial Disclosure Information; No Product/Research Disclosure Information