The future of home oxygen therapy.

Home oxygen therapy is a well-accepted treatment for advanced respiratory disease; however, there are substantial evidence gaps and implementation challenges. The patient experience varies widely; oxygen therapy devices are often poorly matched to patient needs; and adherence is suboptimal. Recent clinical trials have failed to demonstrate positive outcomes of home oxygen therapy across a range of indications and patient groups, raising new questions regarding which patients will benefit. We convened a home oxygen therapy summit, bringing together experts in the fields of hypoxia biology, biomarkers, home oxygen therapy, behavioural science, and clinical trials, to identify the critical steps necessary to advance the science and practice of home oxygen therapy. Prescription of oxygen therapy depends on identification of hypoxaemia, with or without evidence of end-organ dysfunction. However, this does not acknowledge that hypoxaemia does not always yield hypoxia, and ignores adaptation to hypoxia. There is a pressing need for a hypoxia biomarker that is sensitive and specific, reflects the mechanisms of adaptation and maladaptation to chronic hypoxia, and is responsive to change with supplemental oxygen. Advances in research and clinical care will require more "usable" devices that meet the needs of patients and provide value for payers. Optimising oxygen devices will require new technologies with greater portability and greater capacity for oxygen delivery. Registry-based clinical trials may allow measurement of long-term outcomes and identification of patients most likely to benefit from oxygen therapy. Collaborations between patients, clinicians, researchers, payers and industry will be critical to drive this field forward.