Quality statement 9	Ambulatory oxygen therapy (AOT): (a) Patients not eligible for LTOT should only have AOT ordered to facilitate pulmonary rehabilitation or to improve mobility after appropriate formal assessment that includes an exercise test. (b) Patients on LTOT, who are mobile outdoors, should only be offered AOT if this allows them to achieve 15 hours/day compliance with LTOT and/or improve capacity to undertake outdoors activities.
Rationale	Patients who desaturate on exercise may tolerate higher levels of activity with the use of supplemental oxygen during pulmonary rehabilitation; therefore, gains made during pulmonary rehabilitation can be increased. Outside of a pulmonary rehabilitation setting, AOT should not be routinely offered to patients who are not eligible for LTOT. However, some patients, for example with ILD and disabling breathlessness, who do not qualify for LTOT but who desaturate may benefit from AOT, once all other medical interventions have been optimised. This may help improve mobility, by increasing functional capacity and/or time away from home. A formal assessment should be undertaken when considering AOT: this should include an exercise test to measure exercise capacity. In addition there should be consideration of the potential impact of carrying the oxygen equipment. Improved survival has been shown in patients on LTOT who achieve 15 hours per day of oxygen usage. AOT may be considered in patients who are mobile outdoors, who may not otherwise achieve 15 hours of usage. Patients who receive AOT should have compliance data recorded and reviewed annually.
Quality measure	Structure: Evidence of a formal assessment including an exercise test for patients on AOT. Evidence of compliance data for LTOT patients who are mobile outdoors achieving 15 hours per day with AOT. Evidence that compliance in patients receiving AOT but not LTOT is captured and analysed as part of ongoing assessment. Process: The proportion of patients with AOT who have appropriate formal assessment including an exercise test. The proportion of LTOT patients who are mobile outdoors with AOT who achieve 15 hours of usage per day. The proportion of patients on which AOT compliance data are collected.
	Numerator 1: The number of patients on AOT only who have been formally assessed including an exercise test. Denominator 1: The number of patients on AOT only. Numerator 2: The number of LTOT patients with AOT who are mobile outdoors and achieving 15 hours of usage per day. Denominator 2: The number of LTOT patients with AOT. Numerator 3: The number patients with AOT alone with compliance data recorded and reviewed annually. Denominator 3: The number of patients with AOT alone.
Description of what the quality statement means for each audience	Service providers: Ensure systems are in place to offer formal assessments of AOT including an exercise test. Ensure systems are in place for compliance data to be accessed. Healthcare professionals: Ensure formal assessment of AOT which includes an exercise test to help facilitate pulmonary rehabilitation or demonstrate improvement in mobility. Ensure utilisation of compliance data for patients on LTOT with AOT to check daily usage hours. Commissioners: Ensure adequate resources to enable formal assessments for AOT which include an exercise test. Ensure healthcare professionals have access to compliance data via home oxygen provider.
	People who require home oxygen: Are referred and undergo appropriate formal assessment for consideration for AOT provision including an exercise test. Should be consulted about their achievable levels of activity and about what they aspire to gain from increased activity. Where all other medical interventions have been tried, those who remain keen should undergo appropriate formal assessment for consideration of AOT, including an exercise test.
Relevant existing indicators/data sources	Local data collection/audit.
Source references	BTS Guidelines for Home Oxygen Use in Adults June 2015.3
Other information	Online Supplementary file 4, Protocol for ambulatory oxygen therapy assessment from the BTS Guidelines. Refer to the BTS Guideline for Home Oxygen Use in Adults June 2015 for more information about specific patient groups (eg, CF and ILD).3