Editorial ( Long-Term Oxygen Therapy: From "Oxygen-Bars" to Home Oxygen Therapy )

Sandalwood, wintergreen, cranberry, mocha mint, peppermint. New breath mint flavors? New smoothie flavors? No they are flavors of the oxygen offered at oxygen bars across the World. This is a new trend that started among the night clubs in 1990s, since its introduction has caught on, and customers pile up to get this trendy oxygen therapy with the false assumption that they will benefit from it. The therapeutic use of oxygen was pioneered in the early 20th century by the respiratory physiologist John Scott Haldane [1]. He became aware of its therapeutic effects on carbon monoxide poisoning, and was also an advocate of oxygen as a therapeutic agent in other respiratory illness. In 1922, the concept of modern oxygen therapy was introduced by Alvin Barach and since then its use has grown widely [2]. Understanding the effects of hypoxemia and their reversal with oxygen supplementation has made it a common practice [3]. In this issue of Current Respiratory Medicine Reviews, Domingo expands on our understanding of the therapeutic use of oxygen [4]. Long- term oxygen therapy (LTOT) has become standard part of the armamentarium for the treatment of hypoxemic patients with chronic obstructive pulmonary disease (COPD) [5]. In the United States, is estimated that there are 800,000 patients receiving LTOT therapy. Patients who require LTOT have significantly greater annual health care costs than otherwise-similar patients who do not require oxygen therapy [6]. Even though several randomized, controlled trials have tried to demonstrate that LTOT in patients with interstitial lung disease have a beneficial survival effect, they have failed to prove it [7]. On the other hand, it is clear that LTOT improves both the length and the quality of life for patients with chronic hypoxemia and chronic obstructive pulmonary disease (COPD). The improvement in survival with LTOT seems to be proportional to the number of hours of therapy [8]. In patients with hypoxemia, LTOT has shown to improve survival, improving pulmonary hemodynamics and to reduce cardiac work [3]. In patients with airflow obstruction, LTOT increases the distance patients can walk increasing oxygen delivery and its utilization by muscles during exercise [9]. Even though the desire to decrease the work of breathing is not an accepted indication for LTOT, the use of it decreases minute ventilation and subsequently oxygen cost of breathing, helping as well improving one of COPD major symptoms: dyspnea. As noted in the article by Domingo, LTOT is considered safe and is associated with relatively few side effects [4]. Maybe that is the main reason as to why there has been an explosion of "oxygen bars" across the world. This false sense of security has propagated these "bars" in which customers can choose a "flavor" of oxygen to inhale and obtain the "beneficial effects".The use of oxygen, however, needs to be well understood. Identifying the patient that will benefit of LTOT is a very important task that requires a full assessment of the patient and its environment. For LTOT to be successful patient compliance is essential. Patient compliance can be improved by initial and ongoing patient education and by ensuring patient access to appropriate LTOT services, systems and choices that best meet their medical needs. Clearly there are many benefits of oxygen for pulmonary patients and articles such as the one written by Domingo are important for clinicians dealing with patients requiring oxygen supplementation and hoping to avoid the "hype" of oxygen bars! REFERENCES [1] Sternbach GL, Varon J. The discovery and rediscovery of oxygen. J Emerg Med 2005; 28: 221-4. [2] Barach AL. The therapeutic use of oxygen. JAMA 1922; 79: 693-8. [3] Tarpy SP, Celli BR. Long term oxygen therapy. N Engl J Med 1995; 333: 710-4. [4] Domingo C. Home oxygen therapy for the 21st century. Curr Respir Med Rev 2006; 2: 237-51. [5] Eaton T, Lewis C, Young P, et al. Long term oxygen therapy improves health-related quality of life. Respir Med 2004; 98: 285-93. [6] O'Donohue WJ Jr, Plummer AL. Magnitude of usage and cost of home oxygen in the United States. Chest 1995; 107: 301-2. [7] Crockett AJ, Cranston JM, Antic N. Domiciliary oxygen for interstitial lung disease. Cochrane Database Syst Rev 2001; 3. CD002883. [8] Nocturnal Oxygen Therapy Trial Group. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive pulmonary disease. Ann Intern Med 1985; 102: 29-36. [9] Morrison DA, Stovall JR. Increased exercise capacity in hypoxemic patients after long-term oxygen therapy. Chest 1992; 102: 542-50.