Update on the role of palliative oxygen

Breathlessness remains a frequent and burdensome symptom for individuals with life-limiting symptoms in both malignant and nonmalignant settings. As oxygen therapy is frequently given as part of the management of breathlessness and is associated with costs, treatment burden and potential dangers, it is timely to review the efficacy and appropriateness of palliative oxygen therapy.

Despite the widespread use of oxygen therapy in clinical and community settings, data supporting this approach is sparse. The benefits of long-term oxygen therapy for severely hypoxaemic people with chronic obstructive pulmonary disease are proven; however, mounting evidence suggests that oxygen does not confer additional benefit over medical air for the relief of refractory breathlessness in people with mild or absent hypoxaemia.

On the basis of the findings of this review, the routine use of palliative oxygen therapy without detailed assessment of pathogenesis and reversibility of symptoms cannot be justified. Promoting self-management strategies, such as cool airflow across the face, exercise and psychological support for patients and carers, should be considered before defaulting to oxygen therapy. If palliative oxygen therapy is considered for individuals with transient or mild hypoxaemia, a therapeutic trial should be conducted with clinical review after 3 days to assess the net clinical benefit and patient preference.