Enhancing home oxygen therapy: automation to facilitate ambulation

Long-term oxygen therapy (LTOT) is provided in the home for patients with chronic obstructive pulmonary disease (COPD) who present with resting hypoxaemia (SpO2 <88%, PaO2 <60 mm Hg (8 kPa)). In the USA, LTOT is provided to approximately 1.5 million adults at an annual cost of ~$2 billion.1 The evidence base for LTOT remains two landmark studies from four decades ago, demonstrating an apparent dose–response relationship between the daily duration of therapy and mortality.2 3 LTOT is commonly referred to as ‘home’ oxygen therapy which belies the fact that while the modality is provided in the home, the intent is to allow subjects mobility, a return to a more active life and travel outside the home.4 Patients express a desire to be mobile and participate in activities of daily living (ADL).5 Activities, however, are often limited by fatigue, hypoxaemia and dyspnoea. In addition, portable oxygen systems may limit activity owing to insufficient flow, short duration of supply, constant output and portability.4 5 The goals of increased ambulation, however, have to be balanced against the findings that LTOT for moderate exertional hypoxaemia fails to impart a mortality or other patient-important benefit.6 In this issue …