Quality statement 3: Assessment for long‑term oxygen therapy

Quality statement

People with stable chronic obstructive pulmonary disease (COPD) and a persistent resting stable oxygen saturation level of 92% or less have their arterial blood gases measured to assess whether they need long‑term oxygen therapy (LTOT). [2011, updated 2016]

Rationale

LTOT is used to treat people with stable COPD who have developed daytime hypoxaemia. People with COPD and a persistent resting stable oxygen saturation of 92% or less should be assessed for their suitability for LTOT, which can improve survival, pulmonary haemodynamics, polycythaemia and neuropsychological health.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that people with stable COPD and a persistent resting stable oxygen saturation level of 92% or less have their arterial blood gases measured to assess whether they need LTOT.

Data source: Local data collection Royal College of Physicians' National COPD Audit Programme.

Process

Proportion of people with stable COPD and a persistent resting stable oxygen saturation level of 92% or less who have their arterial blood gases measured to assess whether they need LTOT.

Numerator – the number in the denominator who have their arterial blood gases measured to assess whether they need LTOT.

Denominator – the number of people with stable COPD and a persistent resting stable oxygen saturation level of 92% or less.

Data source: Local data collection. Royal College of Physicians' National COPD Audit Programme.

Outcome

a) Hospital admission for acute exacerbation.

Data source: Local data collection.

b) Quality of life.

Data source : Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (primary and secondary care services) ensure that systems are in place for people with stable COPD and a persistent resting oxygen saturation level of 92% or less to have their arterial blood gases measured to assess whether they need LTOT.

Healthcare professionals ensure that they measure the arterial blood gases of people with stable COPD and a persisting resting oxygen saturation level of 92% or less to assess whether they need LTOT.

Commissioners (clinical commissioning groups) ensure that they commission services in which people with stable COPD and a persisting resting oxygen saturation level of 92% or less have their arterial blood gases measured to assess whether they need LTOT.

What the quality statement means for patients, service users and carers

People with COPD that is stable and who have low levels of oxygen in their blood (when checked using a device that clips to their finger) have this confirmed by a blood test, to assess whether they need long‑term oxygen therapy. Long‑term oxygen therapy is treatment with oxygen breathed in through a tube (placed just inside the nose) or a mask connected to an oxygen supply. It is usually given for at least 15 hours during the day or night.

Source guidance

Definitions

Long‑term oxygen therapy (LTOT)

The provision of oxygen therapy for continuous use at home, usually given for at least 15 hours during the day or night.

[Adapted from Chronic obstructive pulmonary disease (NICE guideline CG101)]

Assessment for LTOT

Assessing people for LTOT should comprise measuring arterial blood gases on 2 occasions at least 3 weeks apart in people who have a confident diagnosis of COPD, who are receiving optimum medical management and whose COPD is stable.

[Chronic obstructive pulmonary disease (NICE guideline CG101) recommendation 1.2.5.6]

Stable COPD

The absence of any of the features of a recent acute exacerbation, such as worsening breathlessness, cough, increased sputum production and change in colour of sputum.

[Chronic obstructive pulmonary disease (NICE guideline CG101) recommendation 1.3.1]

Persistent resting stable oxygen saturation

An oxygen saturation (measured with a pulse oximeter) that is persistently 92% or less when the person is in a chronic stable state and is at rest (is not, and has not recently, been exercising).

[Expert opinion]