Does long-term oxygen therapy affect quality of life in patients with chronic obstructive pulmonary disease and severe hypoxaemia?

Abstract

D Do oe es s l lo on ng g--t te er rm m o ox xy yg ge en n t th he er ra ap py y a af ff fe ec ct t q qu ua al li it ty y o of f l li if fe e i in n p pa at ti ie en nt ts s w wi it th h c ch hr ro on ni ic c o ob bs st tr ru uc ct ti iv ve e p pu ul lm mo on na ar ry y d di is se ea as se e a an nd d s se ev ve er re e h hy yp po ox x--a ae em mi ia a? ? ABSTRACT: Long-term oxygen therapy (LTOT) improves survival in patients with hypoxaemic chronic obstructive pulmonary disease (COPD), but previous studies using general health measures have shown no effect on quality of life (QoL). In this study, the effect of LTOT on QoL was assessed using a disease-specific health measure, the St George's Respiratory Questionnaire (SGRQ). Twenty three hypoxaemic COPD patients (15 females and 8 males) were studied before and after starting LTOT: median age 71 (range 47-82) yrs, mean ( The LTOT group had higher SGRQ total scores than controls (p<0.05) at all visits, implying lower QoL. Repeated measures analysis of variance showed no effect of LTOT on QoL over 6 months (F=0.43, p=0.79).In this study we detected no change in quality of life using a disease-specific health measure in patients with severe chronic obstructive pulmonary disease using an oxygen concentrator to provide long-term oxygen therapy. Eur Respir J., 1996Respir J., , 9, 2335Respir J., -2339 Long-term oxygen therapy (LTOT) is a well-established treatment for patients with chronic obstructive pulmonary disease (COPD) and severe hypoxaemia. Two large, randomized studies, the British Medical Research Council (MRC) study and the Nocturnal Oxygen Therapy Trial (NOTT) study from the USA, published in the early 1980s, established that LTOT for at least 15 h·day -1 can reduce mortality in these patients [1, 2]. Other studies have shown physiological benefits of LTOT, including reduction of pulmonary hypertension and secondary polycythaemia [3][4][5][6], and improvements in neuropsychological function [7,8].In addition to having a poor prognosis, patients with severe hypoxaemia and COPD suffer considerable functional disability. Several studies have shown that quality of life is impaired in patients with COPD and hypoxaemia [9][10][11]. Furthermore, in patients with moderateto-severe hypoxaemia, the quality of life score is related to the degree of hypoxaemia when measured using a disease-specific questionnaire [12]. However, the effect of LTOT on quality of life has not been clearly established. In an ancillary study to the NOTT study, there was no improvement in quality of life over 6 months in patients with hypoxic COPD treated with oxygen compared to age-matched controls without COPD [8]. This study used a general health questionnaire, the Sickness Impact Profile (SIP) [13]. In a recent study, this questionnaire did not discriminate between patients with different levels of hypoxia in contrast to a disease-specific measure whose scores were correlated with arterial oxygen tension Pa,O 2 [12]. It is possible that the use of an oxygen concentrator for the provisio...

Influência do sistema de fornecimento de oxigênio na qualidade de vida de pacientes com hipoxemia crônica

“…Applying a general health questionnaire, the Sickness Impact Profile, Heaton et al (21) found no improvement in the quality of life of hypoxemic COPD patients after six months of LTOT delivered by either stationary or portable oxygen delivery systems. Okubadejo et al, (8) using SGRQ, also detected no change in the quality of life of patients with severe COPD receiving oxygen therapy through oxygen concentrators for 6 months.…”

“…(7,8) However, the correlation between HRQoL and arterial oxygenation is controversial in the literature. Previous studies using general health questionnaires have shown no correlations between PaO 2 and qualityof-life measures.…”

“…(2)(3)(4) The association between health-related quality of life (HRQoL) and arterial oxygen tension (PaO 2 ) has been shown; however, the effect of LTOT on HRQoL remains unclear. (5)(6)(7)(8)(9) In addition to decreasing patient mobility and damaging social relationships, LTOT can cause disturbing noise, as well as nasal/ ear discomfort associated with the use of nasal tubes. It has also been associated with financial problems related to electricity consumption when concentrators are used.…”

Interpretation of quality of life scores from the St George's Respiratory Questionnaire

“…Among them, the St. George9s Respiratory Questionnaire (SGRQ) has become one of the most widely used instruments for assessing HRQL in respiratory patients, and has been translated into several languages [1][2][3]. The SGRQ has been used extensively in descriptive [4][5][6][7][8][9] and therapeutic evaluation studies (bronchodilator agents [10], oxygen therapy [11], psychotherapy [12] and respiratory rehabilitation [13]). However, this wide use is restricted mainly to the research setting.…”

Long-term Oxygen Treatment in Chronic Obstructive Pulmonary Disease: Recommendations for Future Research

“…Although indications for LTOT are largely based on mortality data, some prior studies have also suggested improvements in other outcome measures, including depression, cognitive function, quality of life, exercise capability, and frequency of hospitalizations (19)(20)(21)(22)(23)(24)(25)(26)(27). The possibility of functional and clinical improvements in patients with COPD provides an additional, important motivation for the use of LTOT.…”