Effects of long-term oxygen therapy on mortality and morbidity.

In general, based on the above studies of the effects of supplemental oxygen on reducing mortality and improving sleep and exercise function in certain patient groups, patients whose disease is stable on a full medical regimen with PaO2 < or = 55 mm Hg (SaO2 < or = 88%) should be considered for LTOT. Patients with PaO2 of 55-59 mm Hg with signs of tissue hypoxemia (i.e., cor pulmonale, polycythemia, impaired cognition) should also be considered for LTOT. Oxygen therapy should also be considered for those who desaturate during sleep or exercise. These guidelines have been adopted by Medicare as reimbursement criteria and have also been endorsed by the American Thoracic Society. Indications for LTOT endorsed by the American Thoracic Society and published in the "Standards for the Diagnosis and Care of Patients with COPD" are shown in Table 6. More research is required to investigate the use of supplemental oxygen in patients who suffer nocturnal desaturation but do not have signs of end organ dysfunction, those who have an improvement in dyspnea with supplemental oxygen, and in normoxemic patients with impaired exercise performance who improve while inspiring supplemental oxygen.