Go With the Flow: The Dilemma of Long-Term Oxygen Prescription After Recovery

Although major progress has been made in pharmacologic options to treat patients with COVID-19, there is still a lack of evidence on the best noninvasive oxygenation strategy^1,2 to use in the acute phase of the disease as well as a lack of recommendations for the chronic management of long-lasting symptoms.³ The trajectory of recovery after hospitalization in survivors of COVID-19 varies widely, with a high prevalence of patients experiencing long-lasting sequelae and persistence of pulmonary symptoms,⁴ with breathlessness and chronic hypoxemia being the most commonly reported concern.^5,6

Supplemental oxygen therapy is one of the most common treatments used in medicine to manage acute and chronic hypoxemia. However, the clinical practice guideline for effective delivery of long-term oxygen therapy (LTOT)⁷ is mainly based on old studies,^8,-,10 in which survival benefits were demonstrated only in subjects with COPD with severe resting hypoxemia; consequently, this benefit has been assumed indirectly for other patient populations, despite the lack of direct evidence. Indeed, an LTOT prescription has become common practice for managing breathlessness without evidence of hypoxemia and qualifies for reimbursement coverage by the Centers for Medicare and Medicaid.¹¹ Nonetheless, recent studies showed no evidence of benefit from home oxygen for subjects with breathlessness or health-related quality of life in the absence …

Correspondence: Claudia Crimi MD, Department of Clinical and Experimental Medicine, University of Catania, Piazza Università, 2 – 95125 Catania, Italy. Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy, Via S. Sofia, 78 – 95123 Catania, Italy. E-mail: claudia.crimi{at}unict.it