A small but growing body of research, detailed in Table 2, is establishing the usefulness of pulse oximetry in primary care, particularly—but not exclusively—for the management of acute and chronic respiratory disease.
In patients with COPD, pulse oximetry is useful in stable patients with severe disease (FEV1 < 50% predicted), and in patients with worsening symptoms or other signs of an acute exacerbation, as a tool for patients to use at home to assist with their management under physician guidance. It is important to note that pulse oximetry complements, rather than competes with, spirometry in the assessment of COPD patients. Spirometry remains the gold standard for diagnosing and staging COPD, while pulse oximetry provides a method for rapid assessment especially of short-term respiratory compromise.
In patients with asthma, pulse oximetry complements peak flow meters in assessing the severity of asthma attacks/exacerbations and response to a treatment.
In patients with acute respiratory infection, pulse oximetry is useful in evaluating the severity of the illness and, in conjunction with other criteria, determining whether and how to refer patients for further treatment.
Table 2. Current Clinical Uses of Pulse Oximetry in Primary Care
- Establishing a baseline value in patients with stable disease. 4
- Monitoring of patients with exercise-related dyspnea. 4
- In patients with moderate to severe COPD, a screening tool to identify patients (i.e., those with SpO2 <92%) who should be referred for comprehensive oxygen assessment. 3
- In patients with stable COPD or those recovering from an exacerbation at home, an SpO2 88% or less is a strong indication to initiate long-term oxygen therapy. 12 However, ideally the decision to initiate oxygen therapy should be made based on arterial oxygen tension (PaO2 < 7.3 kPa / 55 mm Hg).
- Titrating oxygen flow setting in patients on long-term oxygen therapy, provided their disease is stable and they have good circulation. In general, the goal should be to maintain SpO2 > 90% during all activities. 7
- Evaluation of patients with severe disease (FEV1 < 50% predicted), cyanosis, or cor pulmonale for possible respiratory insufficiency/failure. 4, 7
- Assessment of patients with acutely worsening symptoms, especially dyspnea, and determination of the severity of the exacerbation. 4, 7
- Triage for arterial blood gas measurement, referral to emergency department, and/or determination of whether to initiate oxygen therapy or other treatment for exacerbation. 4
- Monitoring patients after the initiation of oxygen therapy. Measure SpO2 regularly—every 5 to 30 minutes 13, especially if the patient's clinical condition deteriorates. For patients at risk of hypercapnic respiratory failure, aim to maintain SpO2 88-92%; for all other patients, aim for SpO2 94-98%. 14.
- Evaluating patients for initiation of hospital-at-home/intermediate care, and monitoring them once they are enrolled in this form of care. 7
3. Holmes S, and SJ Peffers. 2009. PCRS-UK Opinion Sheet No. 28: Pulse Oximetry in Primary Care. www.pcrs-uk.org.
4. Schermer T, et al. 2009. Pulse oximetry in family practice: indications and clinical observations in patients with COPD.
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6. IPAG guideline. Available from www.thepcrj.org/journ/vol15/15_1_48_57.pdf.
7. Colechin ES, et al. 2010. Evidence review: Pulse oximeters in primary and prehospital care. National Health Service Center for Evidence-Based Purchasing. www.rmpd.org.uk.
8. Lim WS, et al. 2009. BTS guidelines for the management of community acquired pneumonia in adults: update 2009.
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9. British Thoracic Society Scottish Intercollegiate Guidelines Network. 2008. British Guideline on the Management of Asthma.
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10. National Institute for Clinical Excellence. 2004. Chronic obstructive pulmonary disease: national clinical guideline for management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax 59(Suppl 1):1-232.
11. World Health Organization. 2008. 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases. Available from www.who.int/nmh/publications/9789241597418/en/index.html
12. Celli BR, and W MacNee; ATS/ERS Task Force. 2004. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. European Respiratory Journal 23(6):932-46.
13. Hess D. 2000. Detection and monitoring of hypoxemia and oxygen therapy. Respiratory Care 45(1):65-80.
14. British Thoracic Society Emergency Oxygen Guideline Group. 2008. Guideline for emergency oxygen use in adult patients.
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