LONG-TERM OXYGEN-THERAPY - WHO - WITH WHA T - AT WHAT COST

Since 1981 long-term oxygen therapy (LTOT) has become an important pro cedure for the rehabilitation of patients with chronic respiratory ins ufficiency in Switzerland too. As a result of long-term clinical exper ience as well as technical progress, there is, however, increasing nee d for an updated reassessment of guidelines and standardized managemen t respectively: the indications for LTOT - so far restricted to patien ts with COPD - are extended to patients with pulmonary diseases other than COPD associated with chronic hyperemia (pO(2) <7.3 kPa) provided there is enough evidence of clinical benefit. Another important aspect of LTOT focusses on the appropriate application of different oxygen s ources. Oxygen concentrators are still accepted to be the most economi c domiciliary source. For shortterm outdoor activities, small portable cylinders in combination with an oxygen conserving system should be u sed. However, in regular mobile oxygen therapy liquid oxygen is the be st choice, generally consisting of a domiciliary reservoir and portabl e canisters. Delivery of oxygen through a transtracheal catheter is su perior to nasal cannula because of lower oxygen consumption, decreased breathing work and improved compliance respectively. To organize and follow-up LTOT in Switzerland, a very efficient concept was introduced many years ago which is characterized by economical cooperation betwe en physicians, insurances, technical suppliers and social providers. T oday more than 3000 patients corresponding to 38/100 000 inhabitants b enefit from LTOT. Future perspectives should target an earlier start t o continuous as well as mobile LTOT, in order to improve rehabilitatio n in still active conditions instead of merely palliating the terminal stages.