Guide to Prescribing Home Oxygen

by Thomas
L. Petty, M.D.

Contents

The Key
to Prescibing Home Oxygen

Introduction

Keys
to Successful Treatment

Home
Oxygen Options

Conserving
Device Technology

Costs
and Reimbursement

Patient
Considerations in Selecting Equipment

About
Thomas L. Petty, M. D.

For educational
purposes only.

Patient Considerations In Selecting Equipment

Diagnosis

No physician would prescribe insulin or dialysis therapy without a
thorough evaluation, and the same is true for the home oxygen
prescription. Most hospital Respiratory Therapy departments are able to
evaluate home oxygen patients for correct liter flow at rest and during
exercise. The exercise evaluation should be done up to the patient’s usual
level of exercise (10-30 minutes). Oxygen should be prescribed in a
specific liter flow that corrects the hypoxemia and results in an oxygen
saturation of greater than 90% at all conditions of rest, exercise and
sleep. In COPD, the required liter flow to achieve this goal is usually
one to three liters by nasal cannula. Higher flows are required in
advanced cases and for many patients with interstitial lung diseases. When
transtracheal oxygen is the route of delivery, the liter flow can usually
be reduced by approximately 50%. The advantages and disadvantages of
transtracheal oxygen delivery go beyond the scope of this brochure. The
reader is referred to citations 7-8 in the literature.

Rehabilitation Potential

Most patients, if diagnosed early, will benefit from a pulmonary rehab
program if one is available. Rehab not only helps patients rebuild their
stamina but exposure to patients with similar problems seems to have a
profound impact on their self-esteem and it improves their ability to
adjust to their new lifestyle. These groups often meet socially and
provide much-needed emotional support that might otherwise be lacking.
Equipment providing maximum ambulation is recommended for individuals
participating in these groups to facilitate patient participation.
Conservers should be chosen that maintain high SpO2
levels commensurate with the higher activity levels typical of rehab
groups.

Lifestyle is Important

Patient lifestyles are critical. Fitting individual patients’ needs is
incumbent on what they do or would like to be doing. Getting to know your
patients is to be aware of their interests. What kinds of activities do
they participate in? Do they go out a lot? For how long? Or do they stay
at home? Do they perhaps work part-time? What are their hobbies? How can
you best enhance their quality of life with the proper and appropriate
oxygen modality?

CONCLUSION

When selecting the proper modality for LTOT patients, one must consider
their lifestyle and rehab potential. If quality of life goals are set to
be as normal as possible, oxygen devices should be chosen that will allow
the patient to achieve this goal. Each patient’s quality of life goals are
different, however. There is one oxygen system or combination that is
suitable for every patient. This brochure has been prepared to increase
the knowledge and awareness of the importance in selecting the proper
oxygen delivery device.

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