Supplemental Oxygen Therapy in Interstitial Lung Disease: A Narrative Review.

Abstract

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 though estimates suggest it could be as much as 40%, many of whom may require high flow support (>4 L/min). Despite its frequent use, there is limited evidence for supplemental oxygen's impact on clinical outcomes in ILD with recommendations for its use primarily based on older studies in patients with chronic obstructive pulmonary disease (COPD). 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 (CMS) reimbursement policies provides only modest increase in payment for high oxygen flows which may negatively impact access to oxygen services and equipment for some ILD patients. 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.