Oxygen desaturation and breathlessness during corridor walking in chronic obstructive pulmonary disease: effect of oxitropium bromide.

Spence, D. P. S.; Hay, John G.; Carter, J.; Pearson, M; Calverley, P. M. A.

doi:10.1136/thx.48.11.1145

Cited by 70 publications

(55 citation statements)

References 24 publications

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“…The mode of exercise testing may be important. It appears that walking induces a greater degree of arterial desaturation than cycling [54,86,88,286]. The 6-MWT has previously been shown to be sensitive to the administration of supplemental oxygen [287,288].…”

Section: Walking Testsmentioning

confidence: 99%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

Eur Respir J

562

390

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Evidence-based recommendations on the clinical use of cardiopulmonary exercise testing (CPET) in lung and heart disease are presented, with reference to the assessment of exercise intolerance, prognostic assessment and the evaluation of therapeutic interventions (e.g. drugs, supplemental oxygen, exercise training). A commonly used grading system for recommendations in evidence-based guidelines was applied, with the grade of recommendation ranging from A, the highest, to D, the lowest.For symptom-limited incremental exercise, CPET indices, such as peak O 2 uptake (V9O 2 ), V9O 2 at lactate threshold, the slope of the ventilation-CO 2 output relationship and the presence of arterial O 2 desaturation, have all been shown to have power in prognostic evaluation. In addition, for assessment of interventions, the tolerable duration of symptom-limited high-intensity constant-load exercise often provides greater sensitivity to discriminate change than the classical incremental test. Field-testing paradigms (e.g. timed and shuttle walking tests) also prove valuable.In turn, these considerations allow the resolution of practical questions that often confront the clinician, such as: 1) ''When should an evaluation of exercise intolerance be sought?''; 2) ''Which particular form of test should be asked for?''; and 3) ''What cluster of variables should be selected when evaluating prognosis for a particular disease or the effect of a particular intervention?''

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Section: Walking Testsmentioning

confidence: 99%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

Eur Respir J

562

390

View full text Add to dashboard Cite

show abstract

“…5 provides several responses regarding the walking capacity of COPD patients, 6,7 and is useful and sensitive to identify individuals specifically showing desaturation by pulseoximetry. [8][9][10][11] This finding may inform prognosis, since COPD patients with walking desaturation have a higher mortality rate than patients without. 12,13 In daily clinical practice a standard 6MWT can be difficult to execute in non-specialist settings, such as in a general practitioner's office or a healthcare service with low 6MWT expertise.…”

Section: Introductionmentioning

confidence: 99%

Predicting Walking-Induced Oxygen Desaturations in COPD Patients: A Statistical Model

et al. 2013

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BACKGROUND: Oxygen desaturation during walking can have important consequence on prognosis of COPD patients. However, a standard 6-min walk test (6MWT), useful in detecting desaturation in COPD patients, can be difficult to execute in some settings of COPD management, as in the community healthcare service. We evaluated a new scoring system for the risk of oxygen desaturation during walking in COPD patients: the walking desaturation score. METHODS: We collected data from symptomatic COPD in-patients admitted for rehabilitation (derivation cohort) and out-patients referred to the local community health service (validation cohort). S pO 2 was monitored during 6MWT, and the subjects were classified as walking desaturators or non-desaturators. By a regression analysis model we assigned a weighted score proportional to the measured percentage of explained variance for each variable. Risk estimates were computed as odds ratios. A receiver operating characteristic curve analysis and a Hosmer-Lemeshow goodness-of-fit test were then performed to measure discrimination and calibration of walking desaturation score. RESULTS: Baseline characteristics in the derivation cohort (n ‫؍‬ 435, 74% of whom were walking desaturators) and the validation cohort (n ‫؍‬ 238, 37% of whom were walking desaturators) were different. Resting arterial oxygen saturation measured from an arterial blood sample, P aO 2 , and percent-of-predicted FEV 1 were the variables that predicted walking desaturation. The proportion of walking desaturators (and odds ratio estimate) gradually increased according to walking desaturation score (range 0 -6) and associated categories of desaturation risk (total walking desaturation score: low 0 or 1, high 2-3, very high 4 -6) (chi-square P < .001). There was considerable predictive discrimination (area under the curve 0.90, 95% CI 0.86 -0.93, P < .001), and calibration (Hosmer-Lemeshow chi-square 1.31, P ‫؍‬ .86) values have been shown. CONCLUSIONS: Walking desaturation score accurately predicts and classifies the risk of walking desaturation in COPD patients. ClinicalTrials.gov Number NCT01303913.

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“…The cause of exercise intolerance in such patients is multifactorial, and involves an interaction of respiratory, cardiac and peripheral mechanisms (14). Previous studies suggest that the major causes of exercise desaturation in patients with severe COPD are increases in venous admixture and relative hypoventilation during exercise (15). Other studies have documented exercise hypoxemia in patients with lung disease, and the factors found to predict its occurrence include a baseline saturation below 96% and a low diffusion capacity (16,17).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Nasal Cannulas and the OxyArm in Patients Requiring Chronic Domiciliary Oxygen Therapy

Paul

Otvos

2006

Canadian Respiratory Journal

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OBJECTIVES: The present study was designed to compare the performance of a new oxygen delivery device, the OxyArm (OA) (Southmedic Inc, Canada), with a standard nasal cannula (NC) (Salter-Style 1600, Salter Labs, USA) for both oxygen delivery and patient preference in patients on long-term oxygen therapy (LTOT). DESIGN AND SETTING: Randomized crossover study conducted in an outpatient setting. PATIENTS AND METHODS: Twenty-five clinically stable LTOT patients were randomly assigned to an oxygen device (NC or OA) sequence. The baseline saturation level was determined, and patients were then treated at oxygen flow rates of 2 L/min, 3 L/min, 4 L/min, 5 L/min, 6 L/min and 7 L/min for 10 min each while at rest. Patients were then crossed over to the second device and the procedure was repeated. Oximetry values were then obtained following a 5 min walk test using the same device sequence. Lastly, the patients were sent home for a four-week home OA trial, after which, they filled out a questionnaire. RESULTS: This sample of patients was primarily elderly ex-smokers with severe chronic obstructive pulmonary disease on oxygen therapy for the majority of the day. The primary findings were that the OA and NC were equally effective in delivering oxygen to patients and maintaining their oxygen saturation at both rest (P=0.82) and during a 5 min walk test (P=0.83). A patient's personal experience and comfort were identified as the most important factors in deciding on an oxygen device. Most patients felt that the OA was most suited for oxygen therapy while at rest. CONCLUSIONS: The OA proved to be similar to the NC in delivering oxygen and maintaining saturation in patients on LTOT. The OA is one of the few alternatives to using NCs for these patients and, with its current design, appears to be most suited for resting conditions.

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Oxygen desaturation and breathlessness during corridor walking in chronic obstructive pulmonary disease: effect of oxitropium bromide.

Abstract: Background-Although exercise induced desaturation can occur in patients with chronic obstructive pulmonary disease (COPD), little is known about its frequency during everyday exercise, or how it relates to dyspnoea or prior drug treatment. Methods

Cited by 70 publications

References 24 publications

Recommendations on the use of exercise testing in clinical practice

Recommendations on the use of exercise testing in clinical practice

Predicting Walking-Induced Oxygen Desaturations in COPD Patients: A Statistical Model

Comparison of Nasal Cannulas and the OxyArm in Patients Requiring Chronic Domiciliary Oxygen Therapy

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