Written by Kevin Liu
Spoon Feed
Supplemental oxygen use should be indicated by patient goal and disease, not their oxygen saturation percentage.
Prescribing oxygen? Think outside the box, and define the box
Approximately 1.5 million US adults use long-term oxygen therapy (LTOT), but most qualitatively report poor education, limited equipment options, little support, and impaired independence and quality of life despite having oxygen.
While LTOT in patients with COPD and severe resting hypoxemia (SpO2 ≤88%) reduces mortality, evidence is far weaker for exertional-only or moderate desaturation, especially for interstitial lung disease (ILD) and interstitial pulmonary fibrosis (IPF).
This review reframes oxygen as a clinical milestone requiring thoughtful implementation instead of just a prescription. It outlines a person-centered framework that considers patient preferences, mobility, symptoms, and caregiver needs. Succinctly, it places all of its recommendations into a decision tree and a key considerations chart.
How does this change my practice?
This article reinforces that prescribing LTOT should not be reflexive, but it raises more questions for me than answers. For hospitalized patients, I often refrain from discharging patients with hypoxemia until they have oxygen in hand, but short of a few indications (COPD with severe baseline hypoxemia and ILD/IPF), data are limited on benefit. Instead, this article reframes the conversation around oxygen, showing how we can better approach patients and assess their needs – and in turn, advocate better for them.
Source
A Person-Centered Approach to Supplemental Oxygen Therapy in the Outpatient Setting: A Review. JAMA Intern Med. 2025 Jun 1;185(6):720-733. doi: 10.1001/jamainternmed.2025.0279. Erratum in: JAMA Intern Med. 2025 Jun 1;185(6):747. doi: 10.1001/jamainternmed.2025.2122. PMID: 40193114
