Short burst oxygen therapy for relief of breathlessness in COPD

More evidence against the effect of short burst oxygen therapy, but doubts remain In this issue of Thorax Stevenson and Calverley1 provide more evidence for a lack of effect of short burst oxygen therapy in the relief of dyspnoea following exercise in patients with chronic obstructive pulmonary disease (COPD). This study follows other recent publications that appear to draw the same conclusion. Despite this mounting evidence, oxygen cylinders for “as needed” use are still frequently prescribed at great cost.2,3 Oxygen used in this way is often perceived as life saving by patients, but can this continuing practice of short burst oxygen use for COPD patients be justified in the light of the emerging evidence? Oxygen therapy for the management of chronic COPD comes in various forms. Long term oxygen therapy (LTOT) prescribing has an accepted evidence base and any patient considered for short burst treatment should first have undergone an assessment for LTOT. Ambulatory oxygen has been shown to have some beneficial effect in some patients researched in a number of studies that demonstrate some concordance. It is a continuing challenge to the respiratory establishment, however, that the form of oxygen most commonly prescribed in the UK lacks such an agreed evidence base. Short burst oxygen use for the palliation of dyspnoea is fairly widespread among patients with severe COPD.2 Anecdotally, it is beloved by them and often given at their request by respiratory specialists and general practitioners when other options have been exhausted. When it is given there is some evidence that it is used inconsistently4—either before or after exercise—and that the delivery mode is non-standardised with both face masks and nasal cannulae being used with flow rates set usually at 2 or 4 l/min, but often left to the discretion of the …