Oxygen therapy for interstitial lung disease: a systematic review

Abstract

This review aims to establish the impact of oxygen therapy on dyspnoea, health-related quality of life (HRQoL), exercise capacity and mortality in interstitial lung disease (ILD).We included studies that compared oxygen therapy to no oxygen therapy in adults with ILD. No limitations were placed on study design or intervention type. Two reviewers independently evaluated studies for inclusion, assessed risk of bias and extracted data. The primary outcome was dyspnoea.Eight studies evaluated the acute effects of oxygen (n=1509). There was no effect of oxygen therapy on modified Borg dyspnoea score at end exercise (mean difference (MD) -0.06 units, 95% CI -0.24-0.13; two studies, n=27). However, effects on exercise outcomes consistently favoured oxygen therapy. One study showed reduction in dyspnoea at rest with oxygen in patients who were acutely unwell (MD visual analogue scale 30 mm 48 mm, p<0.05; n=10). Four studies of long-term oxygen therapy (n=2670) had high risk of bias and no inferences could be drawn.This systematic review showed no effects of oxygen therapy on dyspnoea during exercise in ILD, although exercise capacity was increased. Future trials should evaluate whether acute improvements in exercise capacity with oxygen can be translated into improved physical activity and HRQoL.

Idiopathic and immune‐related pulmonary fibrosis: diagnostic and therapeutic challenges

“…46 Oxygen therapy in ILD lacks robust data as highlighted in a recent meta-analysis reviewing the impact of oxygen on dyspnoea, quality of life, exercise capacity and mortality in ILD patients. 47 Whilst improvement in exercise capacity was observed, no demonstrated mortality benefit was seen in any of the referenced studies. Pulmonary rehabilitation has demonstrated benefit in ILD patients, albeit that the benefit is not sustained once exercise programmes cease.…”

“…Van Manen et al propose an ABCDE approach with A ssessment of patients’ needs and values; B acking with education; C o‐morbidities and comfort care; D isease‐modifying treatment and E nd‐of‐life care (Figure ) . Oxygen therapy in ILD lacks robust data as highlighted in a recent meta‐analysis reviewing the impact of oxygen on dyspnoea, quality of life, exercise capacity and mortality in ILD patients . Whilst improvement in exercise capacity was observed, no demonstrated mortality benefit was seen in any of the referenced studies.…”

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

“…Various exercise tests, including walk tests, treadmill tests and cycle ergometry, have been used for in-laboratory assessments. For both diseases, supplemental oxygen therapy has consistently been shown to improve exercise performance during in-laboratory tests, with some reporting a reduction in exertional dyspnoea [62,63]. In addition to small study populations, most of these in-laboratory assessment studies had inadequate study design with a lack of blinding and randomisation.…”

Exertional Desaturation and Prescription of Ambulatory Oxygen Therapy in Interstitial Lung Disease

“…Acute administration of oxygen therapy has been shown to improve exercise capacity during exercise tests in patients with ILD. 10,11 A recent short-term non-blinded crossover trial in patients with ILD indicated potential improvement of quality of life with the use of ambulatory oxygen therapy. 12 However, the long-term effects of ambulatory oxygen therapy in patients with ILD and exertional desaturation have not been evaluated.…”