Table 4.
Summary of ATS Recommendations
| Question | ATS Recommendation | Strength of Recommendation and Level of Evidence |
|---|---|---|
| COPD | ||
| Question 1: Should long-term oxygen be prescribed for adults with COPD who have severe* chronic resting room air hypoxemia? | In adults with COPD who have severe chronic resting room air hypoxemia, we recommend prescribing LTOT for at least 15 h/d. | Strong recommendation, moderate-quality evidence |
| Question 2: Should long-term oxygen be prescribed for adults with COPD who have moderate† chronic resting room air hypoxemia? | In adults with COPD who have moderate chronic resting room air hypoxemia, we suggest not prescribing LTOT. | Conditional recommendation, low-quality evidence |
| Question 3: Should ambulatory oxygen be prescribed for adults with COPD who have severe exertional room air hypoxemia? | In adults with COPD who have severe exertional room air hypoxemia, we suggest prescribing ambulatory oxygen. | Conditional recommendation, moderate-quality evidence |
| ILD | ||
| Question 4: Should long-term oxygen be prescribed for adults with ILD who have severe chronic resting room air hypoxemia? | For adults with ILD who have severe chronic resting room air hypoxemia, we recommend prescribing LTOT for at least 15 h/d. | Strong recommendation, very-low-quality evidence |
| Question 5: Should ambulatory oxygen be prescribed for adults with ILD who have severe exertional room air hypoxemia? | For adults with ILD who have severe exertional room air hypoxemia, we suggest prescribing ambulatory oxygen. | Conditional recommendation, low-quality evidence |
| Liquid oxygen | ||
| Question 6: Should portable liquid oxygen be provided for adults with chronic lung disease who are prescribed continuous oxygen flow rates of >3 L/min during exertion? | In patients with chronic lung disease who are mobile outside of the home and require continuous oxygen flow rates of >3 L/min during exertion, we suggest prescribing portable liquid oxygen. | Conditional recommendation, very-low-quality evidence |
| Education | ||
| Education and safety for patients and caregivers | For all patients prescribed home oxygen therapy, we recommend that the patient and their caregivers receive instruction and training on the use and maintenance of all oxygen equipment and education on oxygen safety, including smoking cessation, fire prevention, and tripping hazards. | Best-practice statement |
Definition of abbreviations: ATS = American Thoracic Society; COPD = chronic obstructive pulmonary disease; ILD = interstitial lung disease; LTOT = long-term oxygen therapy.
*
On the basis of two clinical trials (3, 4), severe hypoxemia is defined as meeting either of the following criteria: 1) PaO2 ≤ 55 mm Hg (7.3 kPa) or oxygen saturation as measured by pulse oximetry (SpO2) ≤ 88% or 2) PaO2 = 56–59 mm Hg (7.5–7.9 kPa) or SpO2 = 89% plus one of the following: edema, hematocrit ≥ 55%, or P pulmonale on an ECG.
†
On the basis of a single clinical trial (5), moderate hypoxemia is defined as an SpO2 of 89–93%. The corresponding PaO2 was not reported in that study.