Table 4: International Guidelines for Use of Long-term Oxygen Therapy in Patients with Stable Chronic Obstructive Pulmonary Disease*.
| Guideline | Severe Hypoxemia |
Moderate Hypoxemia | No Hypoxemia |
|---|---|---|---|
| Ministry of Health and Long-Term Care (15) | PaO2 ≤ 55 mm Hg or SpO2 ≤ 88% | PaO2 56–60 mm Hg plus cor pulmonale, pulmonary hypertension, persistent erythrocytosis, exercise-limiting hypoxemia documented to improve with supplemental oxygen, or nocturnal hypoxemia | Funding assistance is provided to individuals who are not hypoxemic at rest but who exhibit exertional hypoxemia on room air and improved exercise tolerance with oxygen |
| ATS-ERS (49) | PaO2 < 55 mm Hg or SpO2 < 88% | PaO2 55–59 mm Hg or SpO2 of 89% plus at least one of cor pulmonale, peripheral edema, or hematocrit > 55% | PaO2 ≥ 60 mm Hg or SpO2 > 90% with severe nocturnal desaturation and lung-related dyspnea responsive to oxygen |
| GOLD (50) | PaO2 ≤ 55 mm Hg or SpO2 ≤ 88%, with or without hypercapnia | PaO2 56–59 mm Hg or SpO2 of 88% with evidence of pulmonary hypertension, peripheral edema suggesting congestive cardiac failure, or polycythemia (hematocrit > 55%) | No recommendation |
| NICE (51) | PaO2 < 55 mm Hg | PaO2 56–59 mm Hg plus secondary polycythemia, nocturnal hypoxemia (SpO2 < 90% for >30% of the time), peripheral edema, or pulmonary hypertension | No recommendation |
| TSA-NZ (52) | PaO2<55 mm Hg | PaO2 56–59 mm Hg, plus evidence of hypoxic organ damage including right heart failure, pulmonary hypertension, or polycythemia | Nocturnal oxygen may be indicated if SpO2 ≤ 88% for > 30% sleep time, or hypoxia-related sequelae |
| AIPO (2) | PaO2 < 55 mm Hg | PaO2 55–60 mm Hg, plus at least one of hematocrit > 55%, signs of pulmonary hypertension, signs of hypoxia such as peripheral edema or right heart failure or mental decline, and ischemic heart failure | Intermittent oxygen may be indicated for SpO2 < 90% for > 30% sleep time or exercise-related desaturation |
*
Abbreviations: AIPO, Associazione Italiana Pneumologi Ospedalieri; ATS-ERS, American Thoracic Society and European Respiratory Society; GOLD, Global Initiative for Obstructive Lung Disease; mm Hg, millimetres of mercury; NICE, National Institute for Health and Clinical Excellence; PaCO2, arterial pressure of carbon dioxide; PaO2, arterial pressure of oxygen; SpO2, oxygen saturation level measured by pulse oximetry TSA-NZ, Thoracic Society of Australia and New Zealand.