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Integrated respiratory care
P103 The practice of prescription of long-term oxygen therapy to patients who continue to smoke
  1. C K Y Lee,
  2. J Noble,
  3. D A Wales,
  4. R M Jones
  1. Nevill Hall Hospital, Abergavenny, UK

Abstract

Introduction Although patients who receive long-term oxygen therapy (LTOT) are discouraged from smoking, a substantial proportion of active smokers receive this therapy. There is limited published guidance addressing this issue.

Methods The authors designed a questionnaire consisting of six multiple choice type questions based on the practice of the prescription of LTOT, particularly focusing on the provision of LTOT to active smokers. This was sent to all consultant respiratory physicians in Wales.

Results 35 out of 45 (73%) questionnaires were returned. 17 physicians (49%) did not prescribe LTOT to active smokers, whereas 18 (51%) did. For those who did not prescribe LTOT to smokers, this was according to departmental policy in 9 (53%) and personal practice in 8 (47%). In this group, all respondents stated the reason for not prescribing oxygen was due to risk of harm to the individual, with the majority (88%) also citing risk to other household members. Other reasons included the reduced likelihood of benefit and effectiveness in smokers (35%) and as an incentive to smoking cessation. 7 (41%) of this group would consider prescribing oxygen to smokers as palliation for severe hypoxia and malignancy. Of the physicians who prescribed LTOT to active smokers, 16 (89%) felt there was existing evidence suggesting benefit in both smokers and non-smokers. 10 (55%) of this group considered it unethical to deny patients LTOT and 11 (61%) felt it was the responsibility of individual patients. LTOT was prescribed only after risk and capacity assessment. Contraindications to prescribing LTOT in this group included cognitive impairment and inability to comprehend the risks. 22 (63%) regularly monitored patients' smoking status while on LTOT. Of these, the majority (68%) did so by history alone. 6 (27%) performed Carbon Monoxide monitoring. 31 respondents (89%) routinely counselled patients on risks of fire and burns with continued smoking on LTOT. 22 respondents (63%) had seen burns or injuries from smoking with LTOT on at least one occasion.

Conclusion There are substantial variations in practice among respiratory physicians across Wales and likely nationwide. National guidance on this particular issue needs to be addressed to ensure standardisation of care.

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