Assessment and follow up of patients prescribed long term oxygen treatment

Prescription and use of long term oxygen treatment were audited in a large group of patients after more than five years of use of the guidelines for its prescription.

Patients with a concentrator were interviewed at home with a structured questionnaire in three family health service authorities in East London. Stable oxygen saturation (SaO2) breathing air and oxygen, forced expiratory volume in one second (FEV1) and current and previous dated concentrator meter readings were recorded. A further questionnaire was sent to each patient's general practitioner. Hospital case notes of patients who did not meet the criteria for long term oxygen treatment at reassessment were reviewed.

A total of 176 patients were studied; 84% had chronic obstructive lung disease and 19% admitted to continued smoking; 140 patients had seen a respiratory physician but results of respiratory assessment were available to their general practitioner in fewer than 54 cases. FEV1 was < 1.5 1 in 158 patients but in 67 SaO2 was less than 91% breathing air, mainly in patients with chronic obstructive lung disease who had been inadequately assessed. Daily oxygen was prescribed for a median of 15 (range 4-24) hours and measured daily use was 15 (0-24) hours; 74% of patients used more than 12 hours. Only 35 patients had problems with oxygen treatment, but 29 had an undercorrected SaO2 of less than 92% when using their concentrator.

Guidelines for prescription of long term oxygen treatment are largely followed and most patients complied with treatment. Increased communication about respiratory state is required between hospital doctors and general practitioners. Patients need regular reassessments to ensure that hypoxaemia is corrected and that oxygen is appropriately prescribed.