The rationale of long-term oxygen therapy (LTOT) for patients with COPD is based on a theoretical desirability of correcting chronic hypoxaemia over the long term, rather than on concern about acute hypoxaemia. Patients with severe COPD develop chronic hypoxaemia, which leads to pulmonary hypertension, cor pulmonale, secondary polycythaemia and reduced survival. The rationale for LTOT is to prevent or slow these complications of chronic hypoxaemia and improve survival. Two large randomized trials demonstrated that LTOT does indeed improve survival in hypoxaemic patients with COPD [1,2]. The aim of LTOT is to improve survival by the regular use of oxygen for sufficient hours to prevent the complications of chronic hypoxaemia in COPD. The aim of LTOT is commonly misunderstood; it is not to improve breathlessness, nor for the majority of patients is it needed to correct life-threatening hypoxaemia. A domiciliary oxygen concentrator is the most commonly used method for providing LTOT.
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