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LTOT Criteria COPD — RACP Adult Medicine MCQ

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ModerateRespiratoryLTOT Criteria COPDRACP Adult Medicine

A 65-year-old man with COPD (FEV₁ 28%) on LTOT has PaO₂ 52 mmHg on room air. He uses oxygen 2L via nasal cannula for 18 hours/day. His resting SpO₂ on oxygen is 92%. He asks about continuing oxygen. What is the survival benefit criterion for LTOT in COPD?

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Correct answer: E — PaO₂ ≤55 mmHg (or ≤59 with cor pulmonale/polycythaemia)

LTOT improves survival in COPD when: PaO₂ ≤55 mmHg on room air, or PaO₂ 56-59 with evidence of cor pulmonale, polycythaemia (Hct >55%), or pulmonary hypertension. Must be stable (measured on 2 occasions ≥3 weeks apart). Must use ≥15 hours/day (NOTT/MRC trials). The LOTT trial showed no benefit of supplemental O₂ for moderate hypoxaemia (SpO₂ 89-93%). Target SpO₂ 88-92% in COPD.

Reference: COPD-X 2024; TSANZ LTOT Position Statement