The recent death of two patients registered in our respiratory home care programme stimulated this reflection regarding oxygen therapy in current smokers. Both had oxygen dependent chronic obstructive pulmonary disease (COPD) and died from severe burns and inhalation injury that occurred while they were receiving oxygen through their home oxygen concentrator. The inquiries revealed that both were smoking when the accidents happened and that their oxygen concentrator was functioning properly.

Contrary to popular belief, oxygen is not explosive. Rather, oxygen accelerates combustion and is therefore an obvious fire hazard. Several reports underlining the risks of burn in patients who smoke while receiving oxygen have been published.¹ Reports of death are rare, however. Nevertheless, the proportion of active smokers among patients who receive long term oxygen therapy (LTOT) is almost never mentioned in the current literature. In the few reports that courageously and specifically addressed this issue, the proportion reached almost 20%.² Such is our own experience.³ Those who report that none of their patients on home oxygen therapy currently smokes do not know their patients well.

Smokers get home oxygen therapy because physicians prescribe it. Why is that so? An explanation may be that, in the British Medical Council’s trial of LTOT in COPD, smoking was not an exclusion criterion even if, at study entry, all patients were “urged …