Views on palliative oxygen have changed but remain inconsistent between specialties

Doctors are prescribing palliative oxygen therapy less often for COPD patients than they did in the past but there’s still a widespread belief that it can relieve breathlessness in some patients.

A 2015 survey of 440 respiratory medicine and palliative medicine specialists in Australia, New Zealand and the UK found most palliative medicine doctors (73%) and just over half (57%) of the respiratory physicians believed oxygen can relieve breathlessness.

These rates were slightly higher than those from a similar 2003 survey, which found 69% of palliative medicine doctors and 48% of respiratory physicians agreed that palliative oxygen relieved breathlessness.

However oxygen prescription from respiratory physicians had halved from 82% in 2003 to 40% in 2015, in line with clinical guidelines, and fewer palliative medicine doctors were recommending it (down from 95% in 2003 to 70% in 2015).

The findings, published in the Internal Medicine Journal, highlight the fact that palliative oxygen therapy remains a grey area for many specialists.

Dr Natasha Smallwood, from the Royal Melbourne Hospital and a coauthor on the paper, told the limbic oxygen that is not beneficial and will be burdensome for most patients with end-stage COPD.

“I think people understand that for the vast majority of patients it doesn’t work; it is not a helpful therapy. But there are maybe a handful of people where it is useful. So it’s a really nuanced thing … a grey area.”

“There has been over the last 10 to 12 years, increasing evidence about the burden of oxygen therapy and that it doesn’t seem to be useful for the vast majority of people. It actually does not appear to be useful when you look at the clinical trials.

“I think people acknowledge that when you look at the clinical trial data it is not helpful, but anecdotally, all of us will get the odd patient.”

“Most respiratory physicians would say ‘don’t do it’ because the risks outweigh the benefits but equally, most of us are willing to consider the odd person where we will try it objectively over a week and if there is evidence we will do it.”

Dr Smallwood said while the attitude of respiratory physicians to palliative oxygen has moved considerably in the last 12 years, palliative medicine colleagues had a slightly different approach.

“It’s still a bit of a clinical issue between the two specialties. While our views are more aligned, I think we are quite determined in respiratory medicine to say it isn’t the right thing to do, so let’s not do it, whereas I think palliative care see it as an option more frequently than we do.”

She added that while there was more evidence for low-dose opioids to relieve breathlessness, oxygen was more acceptable to patients.

“People are much more willing to accept oxygen than they are to accept an opioid even though they are both quite stigmatised treatments.”

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