Mayo Clinic Proceedings Home

Burn Injury Associated With Home Oxygen Use in Patients With Chronic Obstructive Pulmonary Disease



      To quantify the risk of burn injury associated with home oxygen use and to examine the risk factors associated with the development of this injury.

      Patients and Methods

      We used a nested case-control and a retrospective cohort design to study enrollment and claims data from a national sample of Medicare beneficiaries 66 years and older with a diagnosis of chronic obstructive pulmonary disease (COPD) from January 1, 2001, through December 31, 2010. The primary outcome was burn injury in patients with COPD prescribed home oxygen.


      In the nested case-control method, patients with burn injury were twice (odds ratio, 2.43; 95% CI, 1.57-3.78) as likely to be prescribed oxygen in the preceding 90 days compared with those without burn injury. In the retrospective cohort study, the absolute risk of burn injury in patients prescribed oxygen therapy was 2.98 per 1000 patients compared with 1.69 per 1000 patients not prescribed oxygen during a 22-month period. The excess risk of a burn injury associated with oxygen was 0.704 per 1000 patients per year, and the number needed to harm was 1421. In multivariable analysis, factors associated with burn injury included male sex, low socioeconomic status, oxygen therapy use, and the presence of 3 or more comorbidities.


      The benefits of oxygen therapy in patients with COPD outweigh the modest risk of burn injury associated with home oxygen use. However, with the increasing number of patients being prescribed oxygen, health care professionals must educate and counsel patients regarding the potential risk of burn injury.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Medical Research Council Working Party
        Long-term home oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema.
        Lancet. 1981; 1: 681-686
        • Nocturnal Oxygen Therapy Trial Group
        Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial.
        Ann Intern Med. 1980; 93: 391-398
        • Anthoninsen N.R.
        • Skeans M.A.
        • Wise R.A.
        • et al.
        • The Lung Health Study Research Group
        The effects of a smoking cessation intervention on 14.5-year mortality.
        Ann Intern Med. 2005; 142: 233-239
        • Vestbo J.
        • Hurd S.S.
        • Agusti A.G.
        • et al.
        Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: GOLD executive summary.
        Am J Respir Crit Care Med. 2013; 187: 347-365
        • Zielinski J.
        Indications for long term oxygen therapy: a reappraisal.
        Monaldi Arch Chest Dis. 1999; 54: 178-182
        • Christopher K.L.
        • Porte P.
        Long term oxygen therapy.
        Chest. 2011; 139: 430-434
        • Pelletier-Fleury N.
        • Lanoe J.L.
        • Fleury B.
        • Fardeau M.
        The cost of treating COPD patients with long-term oxygen therapy in a French population.
        Chest. 1996; 110: 411-416
        • Serginson J.G.
        • Yang I.A.
        • Armstrong J.G.
        • et al.
        Variability in the rate of prescription and cost of domiciliary oxygen therapy in Australia.
        Med J Aust. 2009; 191: 549-553
        • Croxton T.L.
        • Bailey W.C.
        Long-term oxygen treatment in chronic obstructive pulmonary disease: recommendations for future research: an NHLBI workshop report.
        Am J Resp Crit Care Med. 2006; 174: 373-378
      1. Ahrens M. National Fire Protection Association. Fires and Burns Involving Home Medical Oxygen. Accessed July 8, 2014.

        • Meuhlberg T.
        • Smith M.A.
        • Wong L.
        Domiciliary oxygen and smoking: an explosive combination.
        Burns. 1998; 24: 658-660
        • Robb B.W.
        • Hungness E.S.
        • Hershko D.D.
        • et al.
        Home oxygen therapy: adjunct or risk factor?.
        J Burn Care Rehabil. 2003; 24: 403-406
        • Edelman D.A.
        • Maleyko-Jacobs S.
        • White M.T.
        • Lucas C.E.
        • Ledgerwood A.M.
        Smoking and home oxygen therapy a preventable public health hazard.
        J Burn Care Res. 2008; 29: 119-122
        • Chang T.T.
        • Lipinski C.A.
        • Sherman H.F.
        A hazard of home oxygen therapy.
        J Burn Care Rehabil. 2001; 22: 71-74
        • Morrison D.
        • Skwarski K.
        • Mac Nee W.
        Review of prescription of domiciliary long term oxygen therapy in Scotland.
        Thorax. 1995; 50: 1103-1105
        • Lacasse Y.
        • Lecours R.
        • Pelletier C.
        • Bégin R.
        • Maltais F.
        Randomised trial of ambulatory oxygen in oxygen-dependent COPD.
        Eur Respir J. 2005; 25: 1032-1038
        • Ringbaek T.J.
        • Lange P.
        The impact of the Danish Oxygen Registry on adherence to guidelines for long term oxygen therapy in COPD patients.
        Respir Med. 2006; 100: 218-225
      2. Centers for Medicare and Medicaid Services. Medicare Program-General Information: Overview. November 2010. Accessed January 10, 2014.

      3. Research Data Assistance Center. Medicare Data File Descriptions. October 1, 2010. Accessed January 10, 2014.

        • Elixhauser A.
        • Steiner C.
        • Harris D.R.
        • Coffey R.M.
        Comorbidity measures for use with administrative data.
        Med Care. 1998; 36: 8-27
        • King M.S.
        • Lipsky M.S.
        • Sharp L.
        Expert agreement in Current Procedural Terminology evaluation and management coding.
        Arch Intern Med. 2002; 162: 316-320
        • Cranston J.M.
        • Crockett A.J.
        • Moss J.R.
        • Alpers J.H.
        Domiciliary oxygen for chronic obstructive pulmonary disease.
        Cochrane Database Syst Rev. 2005; : CD001744
        • Stoller J.K.
        • Panos R.J.
        • Krachman S.
        • et al.
        Oxygen therapy for patients with COPD: current evidence and the long-term oxygen treatment trial.
        Chest. 2010; 138: 179-187
        • Gorecka D.
        • Gorselak K.
        • Sliwinski P.
        • Tobiasz M.
        • Zielinski J.
        Effect of long term oxygen therapy on survival in patients with chronic obstructive pulmonary disease with moderate hypoxaemia.
        Thorax. 1997; 52: 674-679
        • Chaouat A.
        • Weitzenblum E.
        • Kessler R.
        • et al.
        A randomized trial of nocturnal oxygen therapy in chronic obstructive pulmonary disease patients.
        Eur Respir J. 1999; 14: 1002-1008
        • Pierson D.J.
        Oxygen in respiratory care: a personal perspective from 40 years in the field.
        Respir Care. 2013; 58: 196-204
        • Vercruysse G.A.
        • Ingram W.L.
        A rationale for significant cost savings in patients suffering home oxygen burns: despite many comorbid conditions, only modest care is necessary.
        J Burn Care Res. 2012; 33: e268-e274
        • Al Kassis S.A.
        • Savetamal A.
        • Assi R.
        • et al.
        Characteristics of patients with injury secondary to smoking on home oxygen therapy transferred intubated to a burn center.
        J Am Coll Surg. 2014; 218: 1182-1186
        • Amani H.
        • Lozano D.D.
        • Blome-Eberwein S.
        Brother, have you got a light? assessing the need for intubation in patients sustaining burn injury secondary to home oxygen therapy.
        J Burn Care Res. 2012; 33: e280-e285
        • Centers for Disease Control and Prevention
        Fatal fires associated with smoking during long term oxygen therapy - Maine, Massachusetts, New Hampshire, and Oklahoma, 2000-2007.
        MMWR Morb Mortal Wkly Rep. 2008; 57: 852-854
        • Lacasse Y.
        • LaForge J.
        • Maltais F.
        Got a match? home oxygen therapy in current smokers.
        Thorax. 2006; 61: 374-375
      4. Veterans Health Administration National Center for Ethics in Health Care. Ethical considerations that arise when a home care patient on long term oxygen therapy continues to smoke. 2010 1-15.…/NEC_Report_20100301_Smoking_while_on_LTOT. Accessed July 8, 2014.

        • Bruck D.
        • Ball M.
        • Thomas I.R.
        Fire fatality and alcohol intake: analysis of key factors.
        J Stud Alcohol Drugs. 2011; 72: 731-736