Home oxygen therapy is used for the treatment of chronic hypoxia. It is most commonly prescribed for the management of severe chronic obstructive pulmonary disease (COPD). It may also be considered and prescribed for other respiratory diseases causing chronic hypoxia, once all reversible causes have been identified and treated.

These other respiratory diseases include interstitial lung disease (pulmonary fibrosis), including following COVID-19 pneumonitis, morbid obesity causing nocturnal hypoventilation/obstructive sleep apnoea, and other rarer chronic respiratory diseases. It is occasionally also prescribed for cardiac (chronic heart failure) and other causes of chronic hypoxia. 

Other indications for home oxygen therapy may include:

• chronic hypoxia in neonates and children under the care of paediatric or neonatal teams
• chronic-worsening hypoxia in patients with progressive diseases, including cancer approaching the end of life under the care of the palliative care team
• high flow short burst oxygen therapy may also be prescribed by neurologists for cluster headaches; this is the only indication for oxygen to be prescribed without co-existing hypoxia.

See Downloads for clinical decision tools relating to the prescription and use of home oxygen.

Haringey and Islington HOS-R teams

The Haringey and Islington multi-disciplinary HOS-R team consists of:

• a respiratory consultant physician
• a specialist respiratory pharmacist
• a specialist respiratory nurse or respiratory physiotherapist.

The aims of the Haringey and Islington HOS-R teams are to:

• optimise benefit from oxygen therapy
• reduce harm from trips, falls, smoking, fire and oxygen toxicity
• maximise value from oxygen equipment use
• improve patient and carer experience of having and using home oxygen
• provide the patients with supportive advice on their oxygen therapy.

The HOS-R team remit is to review:

• all adult patients with a new home oxygen prescription from AirLiquide within four weeks
• all adult patients with a home oxygen prescription for respiratory diseases at least once a year
• all adult patients with a home oxygen prescription whose hypoxia is caused by non-respiratory conditions at least once a year (i.e. not including cluster headaches)
• all adult patients with a home oxygen prescription coded as 'palliative care', with cancer with hypoxia or advanced progressive multi-morbidity with hypoxia, within four weeks, jointly with the relevant palliative care team.

Eligibility Criteria

Inclusions

• adult patients registered with an Haringey or Islington GP who have been prescribed home oxygen as above.

Please note: It is the GP address, not the patient address, that determines which HOS-R team takes on reviewing a patient.

Exclusions

Home oxygen therapy is only one component of the management of patients with severe and/or complex respiratory disease who also need to continue under the care of a respiratory team. In particular, this patient group is often also living with disabling and/or frightening breathlessness. Hence, the Haringey and Islington HOS-R services does not provide:

• oxygen assessments for new prescriptions:
  • referrals for assessment for a new oxygen prescription should be made as a referral to a respiratory clinician/respiratory service; before a new prescription for home oxygen, patients need a specialist respiratory assessment in order to:
    • review diagnosis and reason for deterioration
    • optimise treatment that might reverse hypoxia
    • review impact, understanding and management of breathlessness
    • start advance care planning conversations
    • agree plan for continued respiratory input into care.
  • for new oxygen needs, which usually reflect a change in disease course (e.g. change in ambulatory oxygen needs); referrals for assessment should be made back to the respiratory team looking after the patient's underlying condition. 
  • for acute deterioration (worsening hypoxia), patients should be referred for urgent respiratory review/admission for diagnosis and management of new respiratory failure.
• reviews for patients prescribed oxygen for cluster headaches by neurologists:
  • queries for this patient group should be addressed to their neurologist.

How to Refer

Locations

HOS-R Community Clinic