Long-term oxygen therapy not beneficial for COPD patients with moderate desaturation
Long-term supplemental oxygen has no benefit in patients with stable COPD and resting or exercise-induced moderate desaturation.
Long-term supplemental oxygen does not provide any benefit regarding time to death or first hospitalization among patients with stable chronic obstructive pulmonary disease (COPD) and resting or exercise-induced moderate desaturation, according to a study in the New England Journal of Medicine.
Researchers originally sought to determine whether long-term treatment with supplemental oxygen would result in a longer time to death compared with no use of supplemental oxygen among patients with stable COPD and moderate resting desaturation (oxyhemoglobin saturation as measured by pulse oximetry [Spo2], 89% to 93%). After 7 months with 34 patients, the investigators also included 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 added the time to the first hospitalization for any cause into the new composite primary outcome.
Participants were randomly assigned to receive long-term supplemental oxygen or no long-term supplemental oxygen. In the supplemental-oxygen group, patients with resting desaturation were given 24-hour oxygen, and those with desaturation only during exercise were given oxygen during exercise and sleep.
The researchers followed 738 patients at 42 centers for 1 to 6 years. They 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), nor in the rates of all hospitalizations (rate ratio, 1.01), COPD exacerbations (rate ratio, 1.08), and COPD-related hospitalizations (rate ratio, 0.99). In addition, no consistent between-group differences were observed regarding measures of quality of life, lung function, and the distance walked in 6 minutes.
“We found that the prescription of supplemental oxygen for patients with stable COPD and resting or exercise-induced moderate desaturation did not affect the time to death or first hospitalization, time to death, time to first hospitalization, time to first COPD exacerbation, time to first hospitalization for a COPD exacerbation, the rate of all hospitalizations, the rate of all COPD exacerbations, or changes in measures of quality of life, depression, anxiety, or functional status,” the researchers stated.
“We found no effect on the primary outcome in subgroups of patients defined according to desaturation type, prescription type, or adherence to the regimen,” the investigators continued. “The consistency of the null findings strengthens the overall conclusion that long-term supplemental oxygen in patients with stable COPD and resting or exercise-induced moderate desaturation has no benefit with regard to the multiple outcomes measured.”
- The Long-Term Oxygen Treatment Trial Research Group. A randomized trial of long-term oxygen for COPD with moderate desaturation. NEJM. 2016;375(17):1617-1627.