Ambulatory oxygen for people with chronic obstructive pulmonary disease who are not hypoxaemic at rest

Ameer, Faisal; Carson, Kristin; Usmani, Zafar A; Smith, Brian J.

doi:10.1002/14651858.cd000238.pub2

Cited by 30 publications

(22 citation statements)

References 21 publications

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“…5,6,24 Our findings contrast with the prolonged survival that was observed among patients with COPD and severe desaturation who were treated with supplemental oxygen. 1,2 Possible reasons for this discrepancy are the nonlinear threshold effects of oxygen saturation on pulmonary vasoconstriction, mediator release, and ventilatory drive, 25,26 which occur with an SpO 2 of 88% or less and which may be more important in patients with chronic hypoxemia.…”

Section: Discussioncontrasting

confidence: 90%

A Randomized Trial of Long-Term Oxygen for COPD with Moderate Desaturation

Rk¹,

Dh²,

Al³

et al. 2016

N Engl J Med

342

113

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BACKGROUND Long-term treatment with supplemental oxygen has unknown efficacy in patients with stable chronic obstructive pulmonary disease (COPD) and resting or exercise-induced moderate desaturation. METHODS We originally designed the trial to test whether long-term treatment with supplemental oxygen would result in a longer time to death than no use of supplemental oxygen among patients who had stable COPD with moderate resting desaturation (oxyhemoglobin saturation as measured by pulse oximetry [SpO2], 89 to 93%). After 7 months and the randomization of 34 patients, the trial was redesigned to also include patients who had stable COPD with moderate exercise-induced desaturation (during the 6-minute walk test, SpO2 ≥80% for ≥5 minutes and <90% for ≥10 seconds) and to incorporate the time to the first hospitalization for any cause into the new composite primary outcome. Patients were randomly assigned, in a 1:1 ratio, to receive long-term supplemental oxygen (supplemental-oxygen group) or no long-term supplemental oxygen (no-supplemental-oxygen group). In the supplemental-oxygen group, patients with resting desaturation were prescribed 24-hour oxygen, and those with desaturation only during exercise were prescribed oxygen during exercise and sleep. The trial-group assignment was not masked. RESULTS A total of 738 patients at 42 centers were followed for 1 to 6 years. In a time-to-event analysis, we found no significant difference between the supplemental-oxygen group and the no-supplemental-oxygen group in the time to death or first hospitalization (hazard ratio, 0.94; 95% confidence interval [CI], 0.79 to 1.12; P=0.52), nor in the rates of all hospitalizations (rate ratio, 1.01; 95% CI, 0.91 to 1.13), COPD exacerbations (rate ratio, 1.08; 95% CI, 0.98 to 1.19), and COPD-related hospitalizations (rate ratio, 0.99; 95% CI, 0.83 to 1.17). We found no consistent between-group differences in measures of quality of life, lung function, and the distance walked in 6 minutes. CONCLUSIONS In patients with stable COPD and resting or exercise-induced moderate desaturation, the prescription of long-term supplemental oxygen did not result in a longer time to death or first hospitalization than no long-term supplemental oxygen, nor did it provide sustained benefit with regard to any of the other measured outcomes. (Funded by the National Heart, Lung, and Blood Institute and the Centers for Medicare and Medicaid Services; LOTT ClinicalTrials.gov number, NCT00692198.)

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Section: Discussioncontrasting

confidence: 90%

A Randomized Trial of Long-Term Oxygen for COPD with Moderate Desaturation

Rk¹,

Dh²,

Al³

et al. 2016

N Engl J Med

342

113

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“…A systematic review of four randomised placebo-controlled trials of AOT in patients with COPD concluded that oxygen improved exertional dyspnoea, without survival benefit or enhanced exercise capacity [64]. The review included patients without significant resting hypoxaemia, defined as meeting the criteria for LTOT, with the duration of intervention varying between 2 and 12 weeks.…”

Section: Ambulatory Oxygen Therapy In Copd and Ildmentioning

confidence: 99%

Oxygen therapy in COPD and interstitial lung disease: navigating the knowns and unknowns

et al. 2019

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Domiciliary oxygen therapy is often prescribed for patients with hypoxaemia due to advanced lung disease, most commonly chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). Long-term oxygen therapy (LTOT) trials conducted in patients with COPD in the 1980s remain the basis for clinical decisions and guideline recommendations regarding LTOT for patients with non-COPD conditions as there is a lack of high-quality evidence concerning its use in the non-COPD population. There is also a lack of evidence for the use of ambulatory and nocturnal oxygen therapy in patients with isolated exertional and nocturnal hypoxaemia. These deficiencies pose significant challenges in patient care, with consequent discrepancies in guideline recommendations and clinical approaches. In recent years, new studies have been and are currently being conducted to fill the gaps in our understanding and use of domiciliary oxygen therapy for other indications, including ILD. This article provides a comparison of the epidemiology and significance of hypoxaemia in patients with COPD and ILD, with an up-to-date review of current evidence regarding the role of different types of domiciliary oxygen therapy in these conditions.

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“…Die Laboratorien müssen grundsätzlich geeignet sein, die geforderten Ausbildungsinhalte zu vermitteln. sein, welcher bei diesen Patienten häufig zu finden ist [20,28], und der die Zwerchfellermüdung während Atemmuskelbelastung verstärken kann [32].…”

Section: Laboratorien Für Die Ausbildung Auf Dem Gebiet Der Klinischeunclassified

Gesundheitswesen – Bestechung und Bestechlichkeit – Gesetzeslücken werden geschlossen

2016

Pneumologie

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Ambulatory oxygen for people with chronic obstructive pulmonary disease who are not hypoxaemic at rest

Cited by 30 publications

References 21 publications

A Randomized Trial of Long-Term Oxygen for COPD with Moderate Desaturation

A Randomized Trial of Long-Term Oxygen for COPD with Moderate Desaturation

Oxygen therapy in COPD and interstitial lung disease: navigating the knowns and unknowns

Gesundheitswesen – Bestechung und Bestechlichkeit – Gesetzeslücken werden geschlossen

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