Harmonizing domiciliary oxygen therapy in Canada

Domiciliary oxygen therapy is routinely prescribed for patients with chronic respiratory disease and evidence of hypoxemia, including chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). Despite the evidence supporting this practice, there is considerable variability in medical and reimbursement criteria across Canada. Some provinces offer universal financial support toward domiciliary oxygen for those who need it, whereas other provinces provide coverage only if certain income criteria are met. This heterogeneity leads to inequality of care from one region to the next. Surveys of patients, caregivers and healthcare providers such as those recently developed by the Canadian Pulmonary Fibrosis Foundation highlight many of the real-life challenges around providing domiciliary oxygen. The purpose of this paper is to review key evidence around domiciliary oxygen in COPD and ILD, provide an overview of the Canadian landscape, and recommend harmonized financial and medical criteria to improve the equity of care for patients across the country.