Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease characterized by persistent respiratory inflammation and irreversible airway obstruction, making it difficult for air to flow in and out of the lungs. COPD includes two major conditions: chronic bronchitis and emphysema. Due to impaired gas exchange in the lungs, patients often experience symptoms such as coughing, phlegm production, chest tightness, and shortness of breath.

COPD: A Global Health Threat

Every 10 seconds, one person dies from COPD worldwide. In Taiwan alone, over 5,000 people die from COPD each year.

Research shows that 90% of COPD cases are caused by smoking, yet 40% of diagnosed COPD patients continue to smoke. To prevent COPD, it is essential to quit smoking and avoid exposure to secondhand and thirdhand smoke. COPD patients are also at a higher risk of developing cardiovascular diseases, osteoporosis, diabetes, lung cancer, and other comorbidities, which can severely impact their quality of life and reduce life expectancy.

Long-Term Oxygen Therapy (LTOT) for COPD

There are various home oxygen supply devices available for COPD patients. Physicians recommend suitable oxygen therapy options based on a patient’s mobility, oxygen flow needs, and financial considerations.

Common Oxygen Supply Options:

1. Oxygen Concentrators

   • More cost-effective for long-term use.
   • Large in size, requires electricity, and is not portable.

2. High-Pressure Oxygen Cylinders

   • Available in different sizes.
   • Small cylinders are portable but have limited oxygen capacity and require frequent refilling.

3. Liquid Oxygen

   • Compact, lightweight, and provides a high oxygen capacity.
   • More expensive and requires specialized storage.

4. Portable Oxygen Concentrators (POCs)

   • Increasingly recommended to encourage mobility.
   • More affordable than liquid oxygen while still being portable.

Who Needs Long-Term Oxygen Therapy?

Long-term oxygen therapy (more than 15 hours per day) has been proven to improve survival rates for COPD patients with chronic respiratory failure and severe resting hypoxemia.

Patients meeting the following criteria, as evaluated by a physician, may require long-term oxygen therapy. The need for continuous or intermittent oxygen use should be assessed by a doctor.

1. Arterial oxygen pressure (PaO₂) ≤ 55 mmHg or arterial oxygen saturation (SaO₂) ≤ 88% while breathing room air.
2. For patients with specific conditions (e.g., pulmonary heart disease, congestive heart failure, polycythemia with hematocrit > 56%), PaO₂ between 56–59 mmHg or SaO₂ ≤ 89%.

Conclusions and Recommendations for Stable COPD Patients on Oxygen Therapy

• Long-term home oxygen therapy improves survival rates and quality of life for COPD patients with severe hypoxemia.
• For mild to moderate hypoxemia, LTOT does not improve survival rates.
• Oxygen therapy only at night does not significantly improve survival compared to continuous oxygen therapy.
• Continuous oxygen therapy is more effective than nighttime-only oxygen therapy.

Choosing the Right Oxygen Therapy

• Home oxygen concentrators are commonly used, while portable oxygen cylinders are useful for outdoor activities.
• Liquid oxygen or portable oxygen concentrators (POCs) may be necessary based on mobility needs, budget, and convenience.
• Patients should consult a pulmonologist to determine the best option.

Oxygen Therapy Follow-Up

Patients using long-term oxygen therapy should have their blood oxygen levels re-evaluated every 2–3 months to determine whether to continue, adjust, or discontinue oxygen therapy.

References

1. Taiwan Ministry of Health and Welfare – Chronic Respiratory Diseases (Asthma, COPD)
2. Taiwan Ministry of Health and Welfare – COPD Care Guidelines