Oxygen in ILD is complicated

The stigma associated with oxygen use, its complexity of use and an ‘evidence-free zone’ conspire against achieving optimal management of patients with interstitial lung disease (ILD).

A small survey of Australian physicians’ perceptions and experience with oxygen therapy found patient preference was an important factor in whether or not to prescribe oxygen.

Co-author Dr Yet Khor, a respiratory physician at Austin Health, told the limbic many patients were reluctant to start on oxygen as they saw it as the ‘beginning of the end’.

“One of the questions is whether holding back if the patient doesn’t want oxygen could be a disservice,” she said.

Doctors however had a lower threshold for prescribing domiciliary oxygen therapy in ILD than diseases such as COPD because ‘intuitively we think oxygen might help’.

“The timing of giving oxygen is guided by doctors and patients and we’re not sure if giving oxygen earlier might improve their prognosis,” Dr Khor said.

The survey found symptomatic relief was the main indication for physicians prescribing oxygen despite the lack of evidence.

She said doctors hope that oxygen will help patients get out and about more but instead it sometimes restricted patients and kept them at home.

“Oxygen therapy is not one of the easiest therapies. It has impacts on the patient’s day-to-day activities and is an additional load on many patients.

“The first thing we need to do is provide more education and support when starting patients on oxygen therapy,” she said. “It’s a complicated therapy.”

Follow-up after starting oxygen therapy was also important, she said.

Dr Khor said the lack of evidence and clinical guidance in the area meant variable practice throughout Australia.

The survey found doctors were also concerned that oxygen prescription in ILD was based on studies conducted in COPD patients.

“The ILD population is quite different to the COPD population. Oxygen drops earlier in the disease course and is more significant so while we thought intuitively these patients will benefit more from oxygen, the evidence is equivocal.”

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