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Supplemental Oxygen Therapy in Interstitial Lung Disease: A Narrative Review
Patients with interstitial lung diseases (ILD) often have hypoxemia at rest and/or with exertion, for which supplemental oxygen is commonly prescribed. The number of patients with ILD who require supplemental oxygen is unknown, although estimates suggest it could be as much as 40%; many of these patients may require high-flow support (>4 L/min). Despite its frequent use, there is limited evidence for the impact of supplemental oxygen on clinical outcomes in ILD, with recommendations for its use primarily based on older studies in patients with chronic obstructive pulmonary disease. Oxygen use in ILD is rarely included as an outcome in clinical trials.
Available evidence suggests that supplemental oxygen in ILD may improve quality of life and some exercise parameters in patients whose hypoxemia is a limiting factor; however, oxygen therapy also places new burdens and barriers on some patients that may counter its beneficial effects. The cost of supplemental oxygen in ILD is also unknown but likely represents a significant portion of overall healthcare costs in these patients. Current Centers for Medicare and Medicaid reimbursement policies provide only a modest increase in payment for high oxygen flows, which may negatively impact access to oxygen services and equipment for some patients with ILD. Future studies should examine clinical and quality-of-life outcomes for oxygen use in ILD.
In the meantime, given the current limited evidence for supplemental oxygen and considering cost factors and other barriers, providers should take a patient-focused approach when considering supplemental oxygen prescriptions in patients with ILD.
Target Audience
Pulmonologists, critical care specialists, translational researchers, and clinicians
Learning Objectives
At the conclusion of this activity, learners should be able to:
- Evaluate the evidence related to supplemental oxygen use in ILD
- Describe some limitations of supplemental oxygen delivery devices
- Prescribe supplemental oxygen therapy that meets current CMS prescribing criteria
Accreditation Statement
The American Thoracic Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Disclosure Declaration
Article Authorship Disclosures (as submitted to the ATS prior to article publication date)
Kristopher P. Clark, M.D., (Jacobs School of Medicine and Biomedical Science, Buffalo, New York, USA) reported no relevant financial relationships with ineligible companies.
Howard B. Degenholtz, Ph.D, (University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA) reported no relevant financial relationships with ineligible companies.
Kathleen O. Lindell, Ph.D, R.N., (Medical University of South Carolina, Charleston, South Carolina, USA) reported no relevant financial relationships with ineligible companies.
Daniel J. Kass, M.D., (University of Pittsburgh and the Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, Pittsburgh, Pennsylvania, USA) reported no relevant financial relationships with ineligible companies.
Off-Label Usage Disclosure
None
Disclosures of AnnalsATS CME Planners
The Annals of the American Thoracic Society (AnnalsATS) original research, commentaries, reviews, and educational content of interest to clinicians and clinical investigators in pediatric and adult pulmonary and sleep medicine and medical critical care. The scope of the journal encompasses content that is applicable to clinical practice, the formative and continuing education of clinical specialists, and the advancement of public health.
The publication of articles that meet these goals by itself is only one step in a multi-step process for the translation of evidence-based improvements in are to clinical practice. Testing for CME credit is designed to function as a next step in the process. This is accomplished through a series of questions written by the author(s) to test that readers have the tools needed to translate recommendations for diagnostic and therapeutic clinical care into clinical practice. Members of the AnnalsATS editorial board review these questions and edit these questions for clarity, educational content, and the quality of the evidence supporting the response to the question.
AnnalsATS CME Planners
Margaret M. Hayes, M.D.
Harvard Medical School, Boston MA, USA
Dr. Hayes reported receiving payments as an author for a chapter on heliox for UpToDate.
Silpa Krefft, M.D., M.P.H.
Video Editor, AnnalsATS
University of Colorado, Denver CO, USA
Dr. Krefft reported providing medicolegal consulting in the area of occupational lung disease.
Caroline Okorie, M.D., M.P.H.
Stanford University School of Medicine, Stanford CA, USA
Dr. Okorie reported no financial relationships with ineligible companies..
Instructions to Receive Credit
To receive credit for this journal article:
- Read the journal article. Keep track of how long it takes you to read it.
- Once you open the article, the Post-Test becomes available. After reading the article, answer the post-test questions. You must answer all questions correctly to earn credit. You may take the test as many times as you like.
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- You can view, save and print your Certificate by pressing the Certificate button.
- To review the credits you've earned in this system and reprint certificates, go to the My Learning drop-down list. Then select Transcript.
Available Credit
- 1.00 AMA PRA Category 1 Credit(s)™The American Thoracic Society designates this for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
- 1.00 Participation