Oxygen Therapy Literature Review
Long-Term Oxygen Treatment Trial Research Group. A randomized trial of long-term oxygen for COPD with moderate desaturation. New England Journal of Medicine,2016;375(17), 1617-1627. Retrieved from https://www.nejm.org/doi/pdf/1...
This article begins by talking about 2 tests done in the 1970s to see if long-term treatment with supplemental oxygen reduced mortality in patient with COPD who had severe resting hypoxemia. These studies led to recommendations that supplemental oxygen be given to COPD patients with oxyhemoglobin saturation of less than 89%. Other studies were done after that to see if supplemental oxygen should be given to patients with mild to moderate hypoxemia, but no benefits were found. This group of researchers did their own parallel-group, randomized clinical trial of long-term supplemental oxygen versus no long-term supplemental oxygen in patients with COPD and moderate resting or exercise-induced desaturation.
The study took place between January 2009 and August 2014. Seven hundred, thirty-eight patients were randomized into several groups. Three hundred, sixty-eight patients were randomly assigned to the supplemental-oxygen group and 370 to the no-supplemental oxygen group. In the supplemental-oxygen group, 220 patients were prescribed 24-hour oxygen and 148 were prescribed oxygen during exercise and sleep only. The patients were followed for a period of 1 to 6 years.
The results were that there was no difference between the study groups in the combined outcome of death or first hospitalization for any cause. No significant differences were noted in the subgroups of oxygen prescription, desaturation profile, race, sex, smoking status, nadir Spo2 during exercise, forced expiratory volume in 1 second, BODE index, SF-36 physical-component score, body-mass index, or history of anemia. The patients in the supplemental-oxygen group who had a COPD exacerbation 1 to 3 months before the study lived longer or had a longer time before their first hospitalization than similar patients in the no-supplemental-oxygen group.
The conclusion is that supplemental oxygen provided in the circumstances listed did not prolong death or first hospitalization. The study had some limitations like that some seriously ill patients did not take part in the trial and they may have been the ones that benefited most from the oxygen. There was no masking done, which may have affected the researchers and oxygen delivery was not done with uniform devices.
Petty, TL, McCoy, RW, Doherty, DE. Long Term Oxygen Therapy (LTOT) History, scientific foundations, and emerging technologies. Respiratory Care 2006; 51(5), 1-40.
This article is a comprehensive guide to long-term oxygen therapy (LTOT). It begins with a history that goes all the way back to the eighteenth century when the first exterior oxygen delivery device was used. It quickly moves forward to the twentieth century when studies were done in the 1960s on people with COPD who had better outcomes with LTOT. It also reports on 2 major randomized control trials done that tested the effectiveness of LTOT for COPD. These studies found that Survival was best in patients who received nearly continuous oxygen from an ambulatory system the difference in survival of the patients in the studies could have been related to the duration of oxygen therapy, the method, or both.
The article goes on to talk about oxygen dosing, oxygen toxicity, and oxygen safety. Then it returns to another study that recreated the nocturnal oxygen therapy trial from the twentieth century. The recreation concluded that more studies were needed.
The next topic the article covers is oxygen therapies. One of the main barriers for patients is the cost of the oxygen delivery system. Related to this is a discussion on oxygen conservation. The article also covers the new portable oxygen tanks and the cost effectiveness of using a portable oxygen tank. It mentions the new smaller oxygen tanks that make their own oxygen so a patient never has to worry about running out when they are mobile. The authors say that the portable oxygen tanks of today are a bargain compared to what they used to be.
The article then takes another turn and starts discussing the National Lung Health Education Program (NLHEP), which is designed to identify and treat people in the early stages of COPD (emphysema and related chronic bronchitis). It talks about conferences for respiratory professionals and that is how the article concludes.
Tiep, BL, Carter, R. Portable oxygen delivery and oxygen conserving devices. UptoDate, 2017; 1-25. Retrieved from https://www.uptodate.com/conte...
The article talks about ways to make using portable oxygen devices better by innovations that conserve more oxygen. Oxygen conserving devices provide greater versatility, portability, and cost savings for patients who must use oxygen systems. Portable oxygen can be heavy, bulky and have only so many hours of oxygen available. Then the article goes on to talk about the types of LTOT oxygen conserving devices there were available on the market at the time the article was written. The first component of portable oxygen was nasal cannula that is used with LTOT. These authors say that this is an inefficient system because a small percentage of the oxygen delivered through the nose reaches the alveoli. The oxygen is tainted by the oxygen in the environment too. The authors recommend changing both the type of delivery and the type of oxygen storage that is used rather than the common type of delivery system described above. They recommend using a reservoir. They also suggest using transtracheal catheters.
Another type of LTOT device are the demand oxygen pulse devices. They were developed to conserve oxygen flow and improve patient mobility. The demand oxygen pulse devices have small reservoirs that provide a metered amount of oxygen but only during inspiration. This conserves oxygen. This article also discusses innovations that may come in the future including ones that sense the patient increasing activity and automatically increasing oxygen delivery volume. The device continues the increased oxygen delivery for 50 seconds and then returns to the resting volume. These devices work with the help of motion sensing conservers. A variety of portable oxygen devices are discussed in the article too. They include lightweight compressed gas cylinders, liquid oxygen systems, portable oxygen cylinders, and oxygen delivery device that can be used when flying. This article is quite informative about the types of LTOT devices are available
United Health Care. Home Use of Oxygen (NCD 240.2) Reimbursement Policy. 2013, May 22; Retrieved from Super Coder: https://www.supercoder.com/web...
This article is about how to bill and what is billable in regard to portable oxygen devices used outside the home if one’s Medicare supplemental insurance is United Healthcare Insurance for Medicare Advantage Plans. It is meant for respiratory health professionals who bill Medicare and Medicare supplemental insurance. It is basically information about reimbursement policies of United Health care.
It begins by cautioning that Medicare coverage for portable oxygen only extends to those patients who have significant hypoxemia, which must be proven with medical documentation, laboratory evidence, and health conditions specified. There are lots of intricate details about the documentation that must be provided for a patient to be reimbursed for oxygen of a portable nature. The article offers the same information about the lab documentation that must take place for United Healthcare to reimburse the patient for the costs of a home oxygen tank.
The article lists several conditions for which the coverage is provided, but what is more interesting is what is not covered. This includes angina pectoris without hypoxemia, breathlessness without cor pulmonale or evidence of hypoxemia, severe peripheral vascular disease and terminal illnesses that are not related to the lungs. Medicare, and United Healthcare do not cover oxygen for breathlessness without cor pulmonale because oxygen can exacerbate the condition.
Then the article talks about what sort of issues related to the oxygen tank are covered by Medicare and by United Healthcare insurance such as maintenance of the device, which is not covered. However, United Healthcare will reimburse for maintenance checks on the device up to 5 years after the patient acquires the device. At 5 years they can elect to get a new device and that is covered. The last pages of the article include a lengthy list of the types of oxygen delivery devices that are available and their coding numbers.
