The Department of Health figures indicate that 85 000 patients in England have oxygen at home at an annual cost of about 100 million GBP. It is estimated however that between 24 and 43 % of the oxygen provided is not used or delivers little or no clinical benefit. Some patients may be given oxygen to treat breathlessness but unless they are hypoxic, at rest or on exercise, there can be no benefit and it should not be prescribed. Waste may also result from inappropriate methods of delivery e.g. cylinders for usage of more than 4 hours a day or prescription of ambulatory devices for people confined to the home.

The majority of patients who are prescribed oxygen have respiratory disease, typically COPD (approximately 60 % of all patients requiring oxygen), cystic fibrosis or pulmonary fibrosis and some patients with chronic asthma or sleep disordered breathing. Some patients with cardiac or neurological disease can also benefit from oxygen and it is an important element of palliative care medicine.

The Outcomes Strategy for COPD and Asthma and the subsequent NHS Companion Document to the Strategy suggested the NHS could:

— ensure routine pulse oximetry in people with COPD whose FEV1 is lower than 50 % predicted to identify those who may need long-term home oxygen therapy and, for those identified, ensure structured assessment of need by a home oxygen assessment and review service

The NICE Clinical Guideline for COPD recommends home oxygen assessment and review, stating that:

— the need for oxygen therapy should be assessed in:

— all patients with very severe airflow obstruction (FEV1 < 30 % predicted)

— patients with cyanosis

— patients with polycythaemia

— patients with peripheral oedema

— patients with a raised jugular venous pressure

— patients with oxygen saturations ≤ 92 % breathing air.

— assessment should also be considered in patients with severe airflow obstruction (FEV1 30–49 % predicted).

— the assessment of patients for long-term oxygen therapy (LTOT) should comprise the measurement of arterial blood gases on two occasions at least 3 weeks apart in patients who have a confident diagnosis of COPD, who are receiving optimum medical management and whose COPD is stable.

— patients receiving LTOT should be reviewed at least once per year by practitioners familiar with LTOT and this review should include pulse oximetry.

The NICE Quality Standard for COPD also highlights the importance home oxygen assessment and review:

— People with COPD potentially requiring long-term oxygen therapy are assessed in accordance with NICE guidance by a specialist oxygen service.

— People with COPD receiving long-term oxygen therapy are reviewed in accordance with NICE guidance, at least annually, by a specialist oxygen service as part of the integrated clinical management of their COPD.

The Home Oxygen Service: Good practice guide for assessment and review, published by Primary Care Commissioning, describes the content of a HOS-AR Service for people who might require oxygen therapy

It is imperative that all oxygen patients have the correct assessment to ensure that all patients who require home oxygen receive the correct device at the correct flow rates and have an understanding appropriate to their requirements. Also all patients being considered for the potential benefits of oxygen therapy are assessed to ensure appropriateness of prescribing determine needs and provide the necessary information for the patient to gain optimum therapeutic benefit.

Adults who are prescribed oxygen often have respiratory disease, typically Chronic Obstructive Pulmonary Disease (COPD), cystic fibrosis or pulmonary fibrosis. It is also used as treatment for some hypoxic patients with cardiac disease and some neurological disorders, e.g. cluster headaches. Children with chronic lung disease who live in the community, including survivors of premature birth, may require home oxygen. Oxygen is sometimes also of value for palliation in end-of-life care.