Are there any guidelines on when to initiate home oxygen therapy in patients with chronic obstructive pulmonary disease (COPD)?
—Darren E. Levy, DO, Wellington, Fla.

Long-term low-flow oxygen therapy in the setting of COPD improves quality of life and, in two long-term studies, improved mortality in patients with severe COPD. Medicare guidelines for the reimbursement of this therapy closely parallel the inclusion criteria of patients studied in the trials suggesting a mortality benefit. Most insurance carriers have similar guidelines for reimbursement: (1)Arterial Po2 (Pao2) <55 mm Hg or an arterial oxygen saturation (Sao2) <88%, or (2) Pao2 <59 mm Hg or Sao2 <89% if there is evidence of cor pulmonale, right heart failure, or erythrocytosis (hematocrit >55%). Additional guidelines exist to cover special situations, such as hypoxemia in the setting of sleep-disordered breathing or oxygen desaturations that occur with exercise.
—R. Steven Tharratt, MD, MPVM (119-10)