The use of long-term home oxygen therapy (HOT) has become increasingly common for treatment of chronic pulmonary diseases. Although illegal to smoke while on HOT, there is an increasing incidence of burn injuries in those patients who smoke while on HOT. The importance of recognition of the prevalence of this injury, the obstacles faced when treating these patients, and understanding the proposed algorithmic approach to be taken with patients on HOT, including prescription, reassessment, and prevention of burn injury are outlined in this review. Retrospective epidemiological data including circumstances, admission, treatment, and disposition were collected and reviewed on the patients treated from 1999 to 2008 with burns secondary to smoking while on HOT. Seventeen patients sustained injuries secondary to smoking on HOT over the 9-year period; 9 patients were female and 8 were male. All the patients were on HOT for chronic obstructive pulmonary disease. Mean patient age was 69.1 ± 2.5 years and mean TBSA 2.8 ± 0.4%; 11.8% (2/17) sustained inhalation injury requiring intubation and 23.5% (4/17) required wound debridement and skin grafting. Mean hospital stay was 42.8 ± 12.5 days; 10.3 ± 5.4 days in the burn intensive care unit and 32.5 ± 11.0 days in the ward. Before the burn injury, 23.5% (4/17) lived in long-term care facilities. On discharge from hospital, 47.1% (8/17) were transferred to extended care facilities or other acute care hospitals, and 11.8% (2/17) died during their hospitalization. After recovery, there was a 35.3% reduction in patients able to return home and/or live independently. A significant number of burn injuries secondary to smoking while on HOT was observed. These patients differ from standard burn patients because they are older in age, have higher rates of inhalation injury, and have much longer lengths of hospitalization, despite smaller TBSA injuries. Prevention of this injury would improve the safety of the patient and those around them as well as healthcare resource allocation. A proactive multidisciplinary algorithmic approach is presented which can be used to manage patients on HOT at risk for continued smoking to decrease the incidence and the impact of burn injuries in this patient population.