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Home Oxygen

When to consider it, who funds it, the GP's role — TSANZ-aligned. Reference for health professionals, not advice.

🇦🇺 Australia TSANZ · Lung Foundation
📋 Sources: Thoracic Society of Australia and New Zealand (TSANZ) — Position Statement on adult domiciliary oxygen therapy; COPD-X Concise Guide (Lung Foundation Australia); state and territory equipment program websites linked above. Eligibility thresholds and scheme rules are summarised and may change — verify against the current TSANZ statement and the relevant state scheme before clinical action. General clinical information for health professionals, not a substitute for specialist advice or individual clinical judgement.
⚠️ GPs identify and refer; respiratory specialists prescribe. State funding schemes require a specialist's recommendation and an arterial blood gas. Direct GP prescription is uncommon and rarely funded.

Is this patient likely eligible for LTOT?

For long-term oxygen therapy (LTOT). Eligibility requires the patient to be stable on optimal medical therapy for ≥4–6 weeks and based on arterial blood gas (ABG) on room air, not oximetry. SpO2 is for screening only.

1. ABG result (PaO2 on room air, stable, awake)

Who does what

GP role
  • Identify candidates (chronic resting SpO2 ≤92% on optimal therapy)
  • Optimise: bronchodilators, ICS, pulmonary rehab, smoking cessation
  • Refer to a respiratory physician for ABG & formal assessment
  • Co-management, annual review, exacerbation plan
  • Coordinate equipment delivery & education with the state scheme
Specialist role
  • Perform / interpret ABG on room air, stable, awake
  • Confirm diagnosis & optimisation
  • Prescribe flow rate & duration (usually ≥15 hrs/day for LTOT)
  • Sign the state scheme application
  • Reassess at 1–3 months and annually

Safety — fire risk is real

Active smoking or vaping is generally an absolute exclusion from state schemes and a serious fire hazard. Several states (including Victoria’s SWEP, updated 2025) explicitly extend the exclusion to e-cigarettes and vaping. Document smoking/vaping status and counsel at every contact. Other safety points to cover:
  • No open flames, gas stoves or candles in the same room while in use
  • Keep cylinders/concentrator >1.5 m from heat sources; stored upright, secured
  • Notify the patient's household and electricity supplier (concentrators draw constant power; many state schemes provide a power-cost rebate)
  • Driving with portable cylinders: secure them; some commercial-vehicle and aviation rules apply
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Funding — state & territory schemes

There is no national home oxygen subsidy. Funding sits with state and territory equipment programs; eligibility, copayment and forms vary. The patient's address (not the GP's) determines the scheme. NDIS may fund for participants where it's not a "health" item.

NSW
EnableNSW — Home Respiratory Program
VIC
SWEP — Statewide Equipment Program
QLD
MASS — Medical Aids Subsidy Scheme
WA
WA Health — search "home oxygen"
SA
SA Health — Domiciliary Equipment Service
TAS
TAS Health — community equipment
ACT
ACT Health — equipment loan scheme
NT
NT Government — health services

If a deep link 404s, the state health page is the right destination — search "home oxygen" or "respiratory equipment".

Practical workflow

Types of home oxygen

Long-term oxygen therapy (LTOT) — ≥15 hrs/day, the only modality with mortality evidence (in severely hypoxaemic COPD). Nocturnal oxygen — for desaturation only in sleep (consider OSA workup first). Ambulatory oxygen — for those who desaturate on exertion despite resting eligibility. Palliative oxygen — for refractory dyspnoea at end of life regardless of PaO2. Short-burst oxygen for transient dyspnoea is generally not recommended — no evidence and limited funding.

SpO2 screening → when to send for ABG

A resting SpO2 of ≤92% on optimal therapy in a stable patient is a reasonable threshold to refer for ABG. SpO2 alone is not enough for funding; the state scheme application needs the PaO2 figure.

Common indications
  • COPD with chronic hypoxaemia (the largest group)
  • Interstitial lung disease (ILD)
  • Pulmonary hypertension
  • Cystic fibrosis, bronchiectasis
  • Severe chronic heart failure with hypoxaemia
  • Palliative care (refractory dyspnoea, regardless of PaO2)
Equipment — concentrator vs cylinder vs liquid

Concentrator — mains-powered, the workhorse for home use. Cylinders — backup & portable use, refilled by supplier. Portable concentrators — battery-powered, smaller flow ceiling; useful for ambulatory patients. Liquid oxygen — rarely available now in AU.

Cost to the patient & power rebate

Through a state scheme, equipment supply is heavily subsidised or free; copayments vary. Electricity rebates for concentrator users exist in most states — usually applied for separately through the state energy department, not the equipment program.

Travel & flying

Cabin pressure equivalent to ~2,400 m altitude; PaO2 drops accordingly. Patients on LTOT generally need supplemental oxygen in-flight — arrange with the airline (forms, lead time, approved devices). Hypoxic challenge testing is sometimes recommended for borderline patients.

Palliative oxygen

For refractory dyspnoea at end of life, oxygen is provided regardless of PaO2 thresholds. Pathways differ: hospital outreach, community palliative care, or state scheme palliative streams. Opioids are first-line for dyspnoea in palliative care; oxygen is adjunctive when hypoxaemia is contributing.

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Reference information for healthcare professionals. Direct GP prescription of home oxygen is uncommon and rarely funded — the standard pathway is respiratory specialist assessment, then ongoing GP co-management.