Reevaluation of continuous oxygen therapy after initial prescription in patients with chronic obstructive pulmonary...

Long-term oxygen therapy improves survival and quality of life in hypoxemic patients with chronic obstructive pulmonary disease (COPD). The need for long-term oxygen therapy should be determined when patients are medically stable. The Third Oxygen Consensus Conference recommended reevaluating patients 1-3 months after continuous oxygen therapy (COT) is initiated, if initiated when the patient is medically unstable.

A cross-sectional study was performed to examine how often orders for COT are reevaluated pursuant to the guidelines promulgated by the Third Oxygen Therapy Consensus Conference, and to assess the impact that following these guidelines would have on the cost of COT.

Of 226 patients prescribed home oxygen therapy, 92 had COPD as a primary diagnosis and 57 were prescribed COT. Only 19 (35%) of 55 patients who returned to the clinics were appropriately reevaluated. The rate of appropriate reevaluation was significantly higher among pulmonary physicians than among primary care physicians (65% vs 17%; odds ratio: 9.0; 95% confidence interval: 2.5-32). Of 19 patients who were appropriately reevaluated, 11 (58%) were discontinued from COT. The patients who were discontinued from COT had a significantly higher percent of predicted forced expiratory volume in the first second than those who were not (34 +/- 8.6% vs 25 +/- 8.8%; p = 0.04).

In our study, most patients were clinically unstable when COT was prescribed, and a significant number of patients remained on COT without reevaluation. Up to 60% of those patients could potentially be discontinued from COT if appropriately reevaluated. Referring a patient initiated on COT to a pulmonary specialist for the proper use of oxygen is strongly recommended. Reevaluating such patients in a timely fashion and discontinuing unnecessary oxygen concentrators could possibly save $106-153 million per year in the United States.