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Practice change that resulted from research efforts was oxygen use in patients with COPD. Long-term oxygen therapy (LTOT) at home has been demonstrated to improve survival in patients with COPD and severe resting hypoxemia. These results form the basis for reimbursement and prescription of LTOT to this day. Recent work has demonstrated no outcome benefit of LTOT in stable COPD patients with moderate desaturation at rest or during activity. Oxygen therapy during activity and exercise has been shown to alleviate symptoms and maintain arterial oxygen saturation, but not improve long-term outcomes. Oxygen therapy in COPD has a number of physiologic, functional, and biologic effects, not all of which are completely understood. Oxygen therapy in exacerbations of COPD can be both helpful and harmful. Some barriers that may appear during the implementations of practice change effort are:

Individual barriers like lack of nursing knowledge, skills and awareness regarding changes, lack of professional characteristics. Organizational barriers like limited organization resources, lack of support and supervision, lack of time, lack of training and education.