A Nationwide Structure for Valid Long-Term Oxygen Therapy: 29 year prospective data in Sweden

Context: Long-term oxygen therapy (LTOT) improves prognosis in chronic obstructive pulmonary disease (COPD) with severe hypoxemia. However, adherence to criteria for eligibility and quality of LTOT is often insufficient and varies between countries. Objectives: The aim of this study was to evaluate a national structure for prescription and management of LTOT over three decades in Sweden. Methods: Prospective, population-based study of all 23,909 patients starting LTOT 1987-2015 in the Swedish National Register of Respiratory Failure (Swedevox). We assessed the prevalence, incidence and structure of LTOT; completeness of registration in Swedevox; and validity of prescription and management of LTOT according to seven published quality indicators. Results: LTOT was prescribed by 48 respiratory or medicine units and managed mainly by specialized oxygen nurses. The national incidence increased from 3.9 to 14.7/100,000 inhabitants over the time period. Airways disease was the main underlying cause for prescribing LTOT (n=15,840; 69%)(Fig 1). In 2015, 2,596 patients had ongoing LTOT, a national prevalence of 31.6/100,000; 88% had severe hypoxemia (PaO2 8.0 kPa breathing oxygen; and 98% were non-smokers. Conclusion: We present a structure for valid prescription, management and follow-up of LTOT.