Table. Overview of differences between the BTS (British Thoracic Society) and the DGP (German Respiratory Society) guidelines for LTOT (taken from Magnet et al. [20]).
British guideline of the British Thoracic Society (BTS) |
German guideline of the German Respiratory Society (DGP) |
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1. | Blood gas analysis technique |
Arterial blood gas analysis (ABG) | Capillary blood gas analysis (CBG) |
2. | Criteria for initiation of LTOT in stable patients |
Two ABG analyses at least 3 weeks apart | Three CBG analyses within a 4-week period |
3. | Initiation of LTOT in patients with COPD after exacerbation | Discharge with oxygen supplementation only if patients cannot manage without oxygen, are breathless, and with SpO2 ≤92% at rest (room air); follow-up assessment of LTOT after 8 weeks | Direct, with later follow-up to re-evaluate indication |
4. | Ambulatory oxygen therapy (AOT) for patients without classic indication criteria | Only during rehabilitation | Indicated by resting PaO2 ≤60 mm Hg and by drop in PaO2 during 6MWT or if AOT improves exercise capacity; not indicated by exclusively exercise-induced hypoxemia without increasing dyspnoea and resting PaO2 >55 mm Hg |
5. | Nocturnal oxygen therapy | Only for severe congestive heart failure and in combination with NIV for other diseases | No clear statement—further evaluation by sleep laboratory recommended |
6. | Titration of O2 flow rates | Based on SpO2 (followed by ABG) | Based on CBG |
7. | Follow-up/re-assessment of LTOT |
Home visit within 4 weeks, with first re-assessment after 3 months, and thereafter every 6–12 months | Every 3 months (outpatient setting) |
8. | Patients who smoke | No contraindications | Conflicting information: LTOT is indicated after avoidance of all inhalative noxae; an overview table however states that there are no contraindications |
COPD, chronic obstructive pulmonary disease; LTOT, long-term oxygen therapy; NIV, non-invasive ventilation; PaO2, arterial partial pressure of oxygen;
SpO2, blood oxygen saturation; 6MWT, 6-minute walk test