Introduction:UK figures show that the prescription of home oxygen cylinders for intermittent use is substantial. Aim: To examine GP assessment criteria and prescribing practice for intermittent oxygen therapy in patients with a diagnosis of chronic obstructive pulmonary disease (COPD) in Northern Ireland. Methods:A postal questionnaire was sent to all GPs (n = 534) in two health boards who had prescribed cylinder oxygen in a six month period prior to the study. The questionnaire was piloted to establish reliability and validity. Results:Completed questionnaires were returned by 52% (280/534) of GPs. GPs ‘most frequently’ used advice from hospital specialists [82% (230/280)] to determine the need for intermittent oxygen. Criteria such as breathlessness score on exercise (e.g., BORG), oximetry on exercise, local guidelines or national guidelines were used less frequently or never. Conclusions:Most patients are likely to have been prescribed intermittent oxygen without any objective assessment. Implementation of evidence-based guidelines and a formal oxygen assessment service, would rationalize the use of intermittent oxygen therapy and enable better targeting of this expensive resource.
l. Department of Health, Social Services and Public Safety . Health and Personal Social Services for Northern Ireland, Drug Tariff. Available from www.dhsspsni.gov.uk/(accessed January 2004).
2.
2. Noturnal Oxygen Therapy Trial Group . Continuous or noctumal oxygen therapy in hypoxemic chronic obstructive lung disease . Ann Intern Med1980; 93: 391-398 .
3.
3. Medical Research Council Working Party . Long term domiciliary oxygen therapy hypoxic cor pulmonale complicating chronic bronchitis and emphysema . Lancet1981; 1: 681-686 .
4.
4. Domiciliary Oxygen Therapy Services . Clinical guidelines and advice for prescribers. A report of the Royal College of Physicians, 1999.
5.
5. British Thoracic Society (BTS) . Guidelines for the management of chronic obstructive pulmonary disease . Thorax1997; 52: S1-S28 .
6.
6. Global Initiative for Chronic Obstructive Lung Disease (GOLD) NHLBI/WHO Workshop Summary . Report on the Global strategy for the diagnosis, management and prevention of COPD . Am J Resp Crit Care Med2001; 163: 1256-1276 .
7.
7. Heaney LG , McAllister D , MacMahon J . Cost minimization analysis of provision of oxygen at home: are the Drug Tariff guidelines cost effective?BMJ1999; 319: 19-23 .
8.
8. Okuabdejo AA , Paul EA , Wedzicha WDomiciliary oxygen cylinders: indications, prescription and usage . Resp Med1994; 88: 777-785 .
9.
9. Nandi K , Smith AA , Crawford A et al. Oxygen supplementation before or after submaximal exercise in patients with chronic obstructive pulmonary disease . Thorax2003; 58: 670-673 .
10.
10. Killen JWW , Corris PA . A pragmatic assessment of the placement of oxygen when given for exercise induced dyspnoea . Thorax2000; 55: 544-546 .
11.
11. Marques-Magallanes JA , Storer TW , Cooper CB . Treadmill exercise duration and dyspnea recovery time in chronic obstructive pulmonary disease: effects of oxygen breathing and repeated testing . Resp Med1998; 92: 735-738 .
13. Cohen J.A coefficient of agreement for nominal scales . Educ Psychol Meas1960; 20: 37-46 .
14.
14. Mackinon P , Crompton H , Simpson JCG . An oxygen assessment clinicis it worth it?Thorax2001; 56: S11-S11 .
15.
15. ReviewofDomiciliary Oxygen Services. Available from www.doh.gov.uk/oxygen/(accessed December 2003).
16.
16. Davidson AC , Leach R , George RJD , Geddes DM . Supplemental oxygen and exercise ability in chronic obstructive disease . Thorax1988; 43: 965-971 .
17.
17. O'Donnell DE , D'Arsigny C , Webb KA . Effects of hyperoxia on ventilatory limitation during exercise in advanced chronic pulmonary disease . Am J Respir Crit Care Med2001; 163: 892-898 .
18.
18. Woodcock AA , Gross ER , Geddes DM . Oxygen relieves breathlessness in ‘pink puffers’ . Lancet1981; 1: 907-909 .
19.
19. Mannix E , Manfredi F , Palange P , Dowdeswell IRG , Farber MO . Oxygen may lower the cost of ventilation in chronic obstructive lung disease . Chest1992; 101: 910-915 .
