Peter O'Keeffe ICU SHO

The British Thoracic Society Guidelines

2015- Summary
The British Thoracic Society has provided up-to-date guidance on Oxygen Therapy in the
Home or other non-acute settings.

Key recommendations:
1)
Long term Oxygen Therapy Remains the most evidence-based form of home oxygen
therapy and the new guidelines have made no recommendations to current indications or
thresholds.
2)
The guidelines recommend Ambulatory Oxygen Assessment only in the case of LTOT
patients that are mobile outside
3)
With regard to cancer or end-stage cardiorespiratory disease with severe and intractable
breathlessness, palliative oxygen therapy has no role if resting oxygen levels are normal or only
slightly hypoxaemic but are still above existing LTOT guidelines standards.
4)
Short burst oxygen therapy shouldn't be ordered for use prior to or following exercise in
COPD regardless of resting hypoxaemia or not.
5)
The guidelines provide risk assessent approach for assessing the safey aspects of all types
of oxygen therapy in the home, especially in smokers.1

LTOT
LTOT in COPD
- stable and resting PaO2 < 7.3.
- stable COPD with resting PaO2 < 8.0 and evidence of peripheral odema, polycythaemia or
pulmonary hypertension
-order in patients with resting hypercapnia and fulfillment of other criteria for LTOT (only indicated
for COPD, but no other lung disease).

LTOT in Other Respiratory or Cardiac Disease (Same as COPD except)

-.Consider patients with interstitial lung disease for palliative oxygen therapy.

LTOT in Cystic Fibrosis - Same as COPD

1Hardinge M, Suntharalingam J, Wilkinson T, British Thoracic Society.Thorax. 2015 Jun; 70(6):589-91. Epub 2015 Apr 27.

LTOT in Pulmonary Hypertension -Order if PaO2 less than 8.0

LTOT Neuromuscular or Chest Wall disorders

-NIV is the treatment of choice in cases of T2RF. Additional LTOT should be considered if
hypoxaeia isn't corrected with NIV.

LTOT in Advanced Heart Failure - Same as COPD.

LTOT in Continuing Smokers

-Discuss the potential for limited benefit for patients continuing to smoke.

Referral and Assessement In LTOT

-written and verbal advice for patients at time of referral
-assess with Arterial Blood Gas any patients with resting stable O2 satuation of less than 92% or if
less than 94% but evidence of peripheral oedema, polycythaemia or pulmonary hypertension.

At Discharge
-Formal assessment after 8 weeks of stability (ie 8 weeks from previous exacerbation)

NOCTURNAL OXYGEN THERAPY (NOT)

NOT In COPD
-NOT isn't recommended in patients with COPD that have nocturnal hypoxaemia but fail to meet
criteria for LTOT.

NOT in patients with Cardiac Disease and Nocturnal Desaturation

-can be ordered if severe heart failure and not fulfilling indications for LTOT and have evidence of
sleep disordered breathing leading to daytime symptoms after other causes of nocturnal
desaturation have been excluded and heart failure treatment has been optimised.

NOT in Cystic Fibrosis

-NOT should not be given to CF patients with nocturnal hypoxaemia alone but not fulfilling LTOT
criteria but can be considered if evidence of established ventilatory failure if given with NIV
support.

NOT in ILD -Same as COPD.

NOT in Neuromuscular Weakeness

-Only in conjunction with NIV, in patients who need them.

NOT in OSA, obesity hypoventilation syndrome or overlap syndrome.

- Only in conjunction with NIV or CPAP and still hypoxemic, in patients who need them

AMBULATORY OXYGEN THERAPY

-Should not be routinely offered to those patients not eligible for LTOT
-Offer AOT assessment only to those patients on LTOT if they are mobile outdoors.
-Consider as part of a pulmonary rehab program or during an exercise programme following
assessment showing improvement in exercise endurance.
Additionally good practice guidelines are provided on review, home visits, lifestyle management ,
additional subcriteria for consideration of AOT, flow rates and supplemental AOT in LTOT.

PALLIATIVE OXYGEN THERAPY

-patients with cancer or end-stage cardiopulmonary disease experiencing intractable
breathlessness shouldn't receive treatment with POT if they are non-hypoxaemic or only mildly
hypoxaemic above current LTOT thresholds.
-POT may be considered by specialist teams where there is intractable breathlessness
unresponsive to other treatment- individual assessment can be made in these rare cases.

SHORT BURST OXYGEN THERAPY

SBOT In COPD -Generally not advised at all

SBOT in Cluster Headache -offer in acute attacks

See full guidelines for instructions on flow rate, equipment including mask selection, oxygen
delivery, tracheostomy use, smoking cessation and safety issues.2

2Hardinge M, Annandale J, Bourne S, Cooper B, Evans A, Freeman D, Green A, Hippolyte S, Knowles V, MacNee W, et
al.Thorax. 2015 Jun; 70 Suppl 1:i1-43.