Home Oxygen Therapy (HOT) is one of the greatest achievements in the treatment of chronic respiratory failure in the last quarter century. Oxygen is an essential element for life. Interruprion of oxygen flow to the brain, even for 5 minutes, causes irreversible damage to the cerebral cortex. Such situation occurs in the case of a sudden interruption of mechanical cardiac or air supply interruption to lungs.
Advanced stages of chronic lung diseases lead to impaired oxygenation of the body. The disfunction of the lung occurs during a period of disease and progresses normally slowly until the clinical condition called respiratory failure occurs.
Respiratory failure is recognized if partial oxygen pressure in arterial blood (PaO2) is less than 60 mm Hg, and the partial pressure of carbon dioxide (PaCO2) is bigger than 45 mm Hg in patient examined at rest and breathing ambient air. There are two types of respiratory failure: hypoxic which is partial and hypercapnic that is total.
History of Home Oxygen Therapy
Spectacular results in oxygen therapy in hospital with patients diagnosed with decompensated pulmonary heart, observed in the 60s of the last century, encouraged doctors to transfer this form of treatment to the patient’s home.
It was confirmed that HOT not only prolongs life of diseased but also stabilizes pulmonary hypertension and prevents the disclosure of clinical features of pulmonary heart. HOT improves functioning of central nervous system, supports multiple cognitive functions, and improves the emotional state of patients by reducing the tension, anxiety and depression. HOT causes a reduction of the hematocrit, prevents thromboembolism, prevents respiratory infections and reduces the incidence of hospitalization. Quality of life is improved and the costs carried by health care are reduced. In the US, annual oxygen therapy in home of one patient costs about 3500$ and the cost of one hospitalization of COPD exacerbations is about 10 000 dollars.
In Poland, patients that meet these criteria are entitled to take advantage of the free allocation of oxygen concentrator by resort DLT procedure financed by the National Health Fund.
This source of help is far underused. It is estimated that in Poland about 20,000 patients with respiratory failure are candidates for permanent home oxygen therapy. In 2004 the National Health Fund financed the treatment of about 2,000 patients – which covered 10% of actual needs. Doctors and GP’s directly caring for patients with chronic respiratory failure within general practice and they should strive to provide them with therapy.
In whom and when we may suspect respiratory failure eligible for HOT?
The most common disease leading to respiratory failure is COPD. Approximately 80% of patients using HOT in the world are sick with the disease. Respiratory failure can be suspected in patients with severe disease (FEV <50% predicted). An easy non-invasive way to confirm the suspicion is the measurement of arterial oxygen saturation by pulse oximeter. Read of SaO <90% indicates the need for examination of arterial blood gas (or capillary) or to submit the patient to the nearest HOT center.
In cases of inability to benefit quickly from care of provincial HOT center patient may rent oxygen concentrator and nedded equipment in our company. Ease of use of oxygen concentrator on an “on/off ” principle enables elderly or disabled people to use HOT independently.