Oxygen therapy in interstitial lung disease - navigating benefit and burden

Oxygen therapy is a key component of interstitial lung disease (ILD) management. This review summarizes the current evidence and explores how to balance its benefits and burdens in people with ILD.

Hypoxemia frequently occurs in ILD and is associated with worse prognosis, but the extent to which oxygen therapy modifies outcomes remains uncertain. Observational findings suggest home oxygen therapy may reduce acute exacerbations and hospitalizations in people with ILD with a life-expectancy of more than 1 year. Ambulatory oxygen can improve symptoms and health-related quality of life in some patients; however, recent evidence indicates that portable oxygen concentrators may not improve daily oxygenation, symptoms, or physical activity. In patients with isolated exertional or nocturnal desaturation or significant respiratory symptoms with hypoxemia, careful consideration of individual benefit versus burden is essential within a shared decision-making framework. High-flow oxygen therapy is effective for acute respiratory failure, but its role in palliative care, pulmonary rehabilitation, and especially in the home environment, are areas of ongoing investigation.

Oxygen therapy can support symptom relief in ILD, but its impact on long-term outcomes is unclear. High-quality evidence remains sparse, and advances in oxygen delivery technologies are needed to improve effectiveness while minimizing burden.