Semin Respir Crit Care Med 2010; 31(3): 334-342
DOI: 10.1055/s-0030-1254073
© Thieme Medical Publishers

Oxygen Therapy in Advanced COPD: In Whom Does it Work?

Barry Make1 , 2 , Samuel Krachman3 , Ralph J. Panos4 , Dennis E. Doherty5 , 6 , James K. Stoller7 , 8
  • 1Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Denver Colorado
  • 2COPD Program, National Jewish Health, Denver Colorado
  • 3Sleep Disorders Center, Division of Pulmonary and Critical Care, Temple University School of Medicine, Philadelphia, Pennsylvania
  • 4Pulmonary, Critical Care, and Sleep Division, Cincinnati Veterans Administration Medical Center, Cincinnati, Ohio
  • 5Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, Kentucky
  • 6Veterans Administration Medical Center, Lexington, Kentucky
  • 7Department of Medicine, The Respiratory Institute, Cleveland, Ohio
  • 8Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
Further Information

Publication History

Publication Date:
21 May 2010 (online)

ABSTRACT

Supplemental oxygen therapy is commonly used in patients with advanced chronic obstructive pulmonary disease (COPD) and severe hypoxemia at rest. Use of oxygen in these patients is justified by studies showing a mortality benefit.

However, the use of oxygen in other patients with advanced COPD has not clearly been established. Long-term studies assessing not only mortality but also other outcomes that are important to patients and physicians such as dyspnea, health status, and exercise capacity are lacking. This article reviews the available studies of the use of supplemental oxygen in patients with less severe hypoxemia at rest during the day, hypoxemia occurring only at night, and hypoxemia occurring only with exercise. With the knowledge that studies in patients with advanced COPD and less severe hypoxemia are limited, recommendations are provided on oxygen use in these groups of patients.

REFERENCES

  • 1 Anthonisen N R. Prognosis in chronic obstructive pulmonary disease: results from multicenter clinical trials.  Am Rev Respir Dis. 1989;  140(3 Pt 2) S95-S99
  • 2 Kanner R E, Renzetti Jr A D, Stanish W M, Barkman Jr H W, Klauber M R. Predictors of survival in subjects with chronic airflow limitation.  Am J Med. 1983;  74 249-255
  • 3 Rodriguez-Roisin R, Anzueto A, Bourbeau J et al.. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2009 http://Available at www.goldcopd.com
  • 4 Nocturnal Oxygen Therapy Trial Group . Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial.  Ann Intern Med. 1980;  93 391-398
  • 5 Report of the Medical Research Council Working Party . Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema.  Lancet. 1981;  1 681-686
  • 6 Celli B R, Cote C G, Marin J M et al.. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.  N Engl J Med. 2004;  350 1005-1012
  • 7 McGhan R, Radcliff T, Fish R, Sutherland E R, Welsh C, Make B. Predictors of rehospitalization and death after a severe exacerbation of COPD.  Chest. 2007;  132 1748-1755
  • 8 Oga T, Nishimura K, Tsukino M, Sato S, Hajiro T. Analysis of the factors related to mortality in chronic obstructive pulmonary disease: role of exercise capacity and health status.  Am J Respir Crit Care Med. 2003;  167 544-549
  • 9 Cranston J M, Crockett A J, Moss J R, Alpers J H. Domiciliary oxygen for chronic obstructive pulmonary disease.  Cochrane Database Syst Rev. 2005;  (4) CD001744
  • 10 Górecka DGK, Gorzelak K, Sliwiński P, Tobiasz M, Zieliński J. Effect of long-term oxygen therapy on survival in patients with chronic obstructive pulmonary disease with moderate hypoxaemia.  Thorax. 1997;  52 674-679
  • 11 Haidl P, Clement C, Wiese C, Dellweg D, Köhler D. Long-term oxygen therapy stops the natural decline of endurance in COPD patients with reversible hypercapnia.  Respiration. 2004;  71 342-347
  • 12 Drummond M B, Blackford A L, Benditt J O NETT Investigators et al. Continuous oxygen use in nonhypoxemic emphysema patients identifies a high-risk subset of patients: retrospective analysis of the National Emphysema Treatment Trial.  Chest. 2008;  134 497-506
  • 13 Cormick W, Olson L G, Hensley M J, Saunders N A. Nocturnal hypoxaemia and quality of sleep in patients with chronic obstructive lung disease.  Thorax. 1986;  41 846-854
  • 14 Fleetham J, West P, Mezon B, Conway W, Roth T, Kryger M. Sleep, arousals, and oxygen desaturation in chronic obstructive pulmonary disease: the effect of oxygen therapy.  Am Rev Respir Dis. 1982;  126 429-433
  • 15 Koo K W, Sax D S, Snider G L. Arterial blood gases and pH during sleep in chronic obstructive pulmonary disease.  Am J Med. 1975;  58 663-670
  • 16 Krachman S L, Chatila W, Martin U J National Emphysema Treatment Trial Research Group et al. Effects of lung volume reduction surgery on sleep quality and nocturnal gas exchange in patients with severe emphysema.  Chest. 2005;  128 3221-3228
  • 17 Wynne J W, Block A J, Hemenway J, Hunt L A, Flick M R. Disordered breathing and oxygen desaturation during sleep in patients with chronic obstructive lung disease (COLD).  Am J Med. 1979;  66 573-579
  • 18 Mulloy E, McNicholas W T. Ventilation and gas exchange during sleep and exercise in severe COPD.  Chest. 1996;  109 387-394
  • 19 Fletcher E C, Luckett R A, Goodnight-White S, Miller C C, Qian W, Costarangos-Galarza C. A double-blind trial of nocturnal supplemental oxygen for sleep desaturation in patients with chronic obstructive pulmonary disease and a daytime PaO2 above 60 mm Hg.  Am Rev Respir Dis. 1992;  145 1070-1076
  • 20 Calverley P M, Brezinova V, Douglas N J, Catterall J R, Flenley D C. The effect of oxygenation on sleep quality in chronic bronchitis and emphysema.  Am Rev Respir Dis. 1982;  126 206-210
  • 21 Fletcher E C, Donner C F, Midgren B et al.. Survival in COPD patients with a daytime PaO2 greater than 60 mm Hg with and without nocturnal oxyhemoglobin desaturation.  Chest. 1992;  101 649-655
  • 22 Shepard Jr J W, Garrison M W, Grither D A, Dolan G F. Relationship of ventricular ectopy to oxyhemoglobin desaturation in patients with obstructive sleep apnea.  Chest. 1985;  88 335-340
  • 23 Coccagna G, Lugaresi E. Arterial blood gases and pulmonary and systemic arterial pressure during sleep in chronic obstructive pulmonary disease.  Sleep. 1978;  1 117-124
  • 24 Klink M E, Dodge R, Quan S F. The relation of sleep complaints to respiratory symptoms in a general population.  Chest. 1994;  105 151-154
  • 25 Chaouat A, Weitzenblum E, Kessler R et al.. Sleep-related O2 desaturation and daytime pulmonary haemodynamics in COPD patients with mild hypoxaemia.  Eur Respir J. 1997;  10 1730-1735
  • 26 Fletcher E C, Luckett R A, Miller T, Costarangos C, Kutka N, Fletcher J G. Pulmonary vascular hemodynamics in chronic lung disease patients with and without oxyhemoglobin desaturation during sleep.  Chest. 1989;  95 757-764
  • 27 Flick M R, Block A J. Nocturnal vs diurnal cardiac arrhythmias in patients with chronic obstructive pulmonary disease.  Chest. 1979;  75 8-11
  • 28 Tirlapur V G, Mir M A. Nocturnal hypoxemia and associated electrocardiographic changes in patients with chronic obstructive airways disease.  N Engl J Med. 1982;  306 125-130
  • 29 Chaouat A, Weitzenblum E, Kessler R et al.. A randomized trial of nocturnal oxygen therapy in chronic obstructive pulmonary disease patients.  Eur Respir J. 1999;  14 1002-1008
  • 30 Zieliński J, Tobiasz M, Hawryłkiewicz I, Sliwiński P, Pałasiewicz G. Effects of long-term oxygen therapy on pulmonary hemodynamics in COPD patients: a 6-year prospective study.  Chest. 1998;  113 65-70
  • 31 Panos R J, Eschenbacher W. Exertional desaturation in patients with chronic obstructive pulmonary disease.  COPD. 2009;  6 478-487
  • 32 Cockcroft A, Beaumont A, Adams L, Guz A. Arterial oxygen desaturation during treadmill and bicycle exercise in patients with chronic obstructive airways disease.  Clin Sci (Lond). 1985;  68 327-32
  • 33 Mathur R S, Revill S M, Vara D D, Walton R, Morgan M D. Comparison of peak oxygen consumption during cycle and treadmill exercise in severe chronic obstructive pulmonary disease.  Thorax. 1995;  50 829-833
  • 34 Palange P, Forte S, Onorati P, Manfredi F, Serra P, Carlone S. Ventilatory and metabolic adaptations to walking and cycling in patients with COPD.  J Appl Physiol. 2000;  88 1715-1720
  • 35 Poulain M, Durand F, Palomba B et al.. 6-minute walk testing is more sensitive than maximal incremental cycle testing for detecting oxygen desaturation in patients with COPD.  Chest. 2003;  123 1401-1407
  • 36 Chatterjee A B, Rissmiller R W, Meade K et al.. Reproducibility of the 6-minute walk test for ambulatory oxygen prescription.  Respiration. 2010;  79 121-127
  • 36a Soguel Schenkel N, Burdet L , de Muralt B, Fitting JW. Oxygen saturation during daily activities in chronic obstructive pulmonary disease.  Eur Respir J. 1996;  9 2584-2589
  • 37 García-Talavera I, García C H, Macario C C, de Torres J P, Celli B R, Aguirre-Jaime A. Time to desaturation in the 6-min walking distance test predicts 24-hour oximetry in COPD patients with a PO2 between 60 and 70mmHg.  Respir Med. 2008;  102 1026-1032
  • 38 Nordenfelt I, Svensson G. The transfer factor (diffusing capacity) as a predictor of hypoxaemia during exercise in restrictive and chronic obstructive pulmonary disease.  Clin Physiol. 1987;  7 423-430
  • 39 Owens G R, Rogers R M, Pennock B E, Levin D. The diffusing capacity as a predictor of arterial oxygen desaturation during exercise in patients with chronic obstructive pulmonary disease.  N Engl J Med. 1984;  310 1218-1221
  • 40 Ries A L, Farrow J T, Clausen J L. Pulmonary function tests cannot predict exercise-induced hypoxemia in chronic obstructive pulmonary disease.  Chest. 1988;  93 454-459
  • 41 Knower M T, Dunagan D P, Adair N E, Chin Jr R. Baseline oxygen saturation predicts exercise desaturation below prescription threshold in patients with chronic obstructive pulmonary disease.  Arch Intern Med. 2001;  161 732-736
  • 42 Hadeli K O, Siegel E M, Sherrill D L, Beck K C, Enright P L. Predictors of oxygen desaturation during submaximal exercise in 8,000 patients.  Chest. 2001;  120 88-92
  • 43 Kawakami Y, Terai T, Yamamoto H, Murao M. Exercise and oxygen inhalation in relation to prognosis of chronic obstructive pulmonary disease.  Chest. 1982;  81 182-188
  • 44 Tojo N, Ichioka M, Chida M, Miyazato I, Yoshizawa Y, Miyasaka N. Pulmonary exercise testing predicts prognosis in patients with chronic obstructive pulmonary disease.  Intern Med. 2005;  44 20-25
  • 45 Takigawa N, Tada A, Soda R et al.. Distance and oxygen desaturation in 6-min walk test predict prognosis in COPD patients.  Respir Med. 2007;  101 561-567
  • 46 Fujii T, Kurihara N, Otsuka T et al.. Relationship between exercise-induced hypoxemia and long-term survival in patients with chronic obstructive pulmonary disease [in Japanese].  Nihon Kyobu Shikkan Gakkai Zasshi. 1997;  35 934-941
  • 47 Hiraga T, Maekura R, Okuda Y et al.. Prognostic predictors for survival in patients with COPD using cardiopulmonary exercise testing.  Clin Physiol Funct Imaging. 2003;  23 324-331
  • 48 Vandenbergh E, Clement J, Van de Woestijne K P. Course and prognosis of patients with advanced chronic obstructive pulmonary disease: evaluation by means of functional indices.  Am J Med. 1973;  55 736-746
  • 49 Casanova C, Cote C G, Marin J M et al.. Distance and oxygen desaturation during the 6-min walk test as predictors of long-term mortality in patients with COPD.  Chest. 2008;  134 746-752
  • 50 Selinger S R, Kennedy T P, Buescher P et al.. Effects of removing oxygen from patients with chronic obstructive pulmonary disease.  Am Rev Respir Dis. 1987;  136 85-91
  • 51 Stein DABB, Bradley B L, Miller W C. Mechanisms of oxygen effects on exercise in patients with chronic obstructive pulmonary disease.  Chest. 1982;  81 6-10
  • 52 Jolly E C, Di Boscio V, Aguirre L, Luna C M, Berensztein S, Gené R J. Effects of supplemental oxygen during activity in patients with advanced COPD without severe resting hypoxemia.  Chest. 2001;  120 437-443
  • 53 Helgerud J, Bjorgen S, Karlsen T et al.. Hyperoxic interval training in chronic obstructive pulmonary disease patients with oxygen desaturation at peak exercise.  Scand J Med Sci Sports. 2009 Sep 28;  , [Epub ahead of print]
  • 54 O'Donnell D E, Revill S M, Webb K A. Dynamic hyperinflation and exercise intolerance in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2001;  164 770-777
  • 55 Somfay A, Porszasz J, Lee S M, Casaburi R. Dose-response effect of oxygen on hyperinflation and exercise endurance in nonhypoxaemic COPD patients.  Eur Respir J. 2001;  18 77-84
  • 56 Eaton T, Garrett J E, Young P et al.. Ambulatory oxygen improves quality of life of COPD patients: a randomised controlled study.  Eur Respir J. 2002;  20 306-312
  • 57 Liker E S, Karnick A, Lerner L. Portable oxygen in chronic obstructive lung disease with hypoxemia and cor pulmonale: a controlled double-blind crossover study.  Chest. 1975;  68 236-241
  • 58 McDonald CFBC, Blyth C M, Lazarus M D, Marschner I, Barter C E. Exertional oxygen of limited benefit in patients with chronic obstructive pulmonary disease and mild hypoxemia.  Am J Respir Crit Care Med. 1995;  152(5 Pt 1) 1616-1619
  • 59 Ram F S, Wedzicha J A. Ambulatory oxygen for chronic obstructive pulmonary disease.  Cochrane Database Syst Rev. 2002;  (2) CD000238
  • 60 Emtner MPJ, Porszasz J, Burns M, Somfay A, Casaburi R. Benefits of supplemental oxygen in exercise training in nonhypoxemic chronic obstructive pulmonary disease patients.  Am J Respir Crit Care Med. 2003;  168 1034-1042
  • 61 Wadell K, Henriksson-Larsén K, Lundgren R. Physical training with and without oxygen in patients with chronic obstructive pulmonary disease and exercise-induced hypoxaemia.  J Rehabil Med. 2001;  33 200-205
  • 62 Rooyackers J M, Dekhuijzen P N, Van Herwaarden C L, Folgering H T. Training with supplemental oxygen in patients with COPD and hypoxaemia at peak exercise.  Eur Respir J. 1997;  10 1278-1284
  • 63 Garrod RMC, Mikelsons C, Paul E A, Wedzicha J A. Randomized controlled trial of domiciliary noninvasive positive pressure ventilation and physical training in severe chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2000;  162(4 Pt 1) 1335-1341
  • 64 Nonoyama M L, Brooks D, Lacasse Y, Guyatt G H, Goldstein R S. Oxygen therapy during exercise training in chronic obstructive pulmonary disease.  Cochrane Database Syst Rev. 2007;  (2) CD005372
  • 65 Héraud N, Préfaut C, Durand F, Varray A. Does correction of exercise-induced desaturation by O(2) always improve exercise tolerance in COPD? A preliminary study.  Respir Med. 2008;  102 1276-1286
  • 66 Jensen G, Nielsen H B, Ide K et al.. Cerebral oxygenation during exercise in patients with terminal lung disease.  Chest. 2002;  122 445-450
  • 67 O'Neill B, Bradley J M, Heaney L, O'Neill C, MacMahon J. Short burst oxygen therapy in chronic obstructive pulmonary disease: a patient survey and cost analysis.  Int J Clin Pract. 2005;  59 751-753
  • 68 Okubadejo A A, Paul E A, Wedzicha J A. Domiciliary oxygen cylinders: indications, prescription and usage.  Respir Med. 1994;  88 777-785
  • 69 Roberts C M. Short burst oxygen therapy for relief of breathlessness in COPD.  Thorax. 2004;  59 638-640
  • 70 Woodcock A A, Gross E R, Geddes D M. Oxygen relieves breathlessness in “pink puffers”.  Lancet. 1981;  1 907-909
  • 71 Evans T W, Waterhouse J C, Carter A, Nicholl J F, Howard P. Short burst oxygen treatment for breathlessness in chronic obstructive airways disease.  Thorax. 1986;  41 611-615
  • 72 Killen J W, Corris P A. A pragmatic assessment of the placement of oxygen when given for exercise induced dyspnoea.  Thorax. 2000;  55 544-546
  • 73 McKeon J L, Murree-Allen K, Saunders N A. Effects of breathing supplemental oxygen before progressive exercise in patients with chronic obstructive lung disease.  Thorax. 1988;  43 53-56
  • 74 Rhind G B. Symptomatic oxygen therapy in hypoxic chronic bronchitis.  Thorax. 1986;  41 245
  • 75 Nandi K, Smith A A, Crawford A et al.. Oxygen supplementation before or after submaximal exercise in patients with chronic obstructive pulmonary disease.  Thorax. 2003;  58 670-673
  • 76 Lewis C A, Eaton T E, Young P, Kolbe J. Short-burst oxygen immediately before and after exercise is ineffective in nonhypoxic COPD patients.  Eur Respir J. 2003;  22 584-588
  • 77 Stevenson N J, Calverley P M. Effect of oxygen on recovery from maximal exercise in patients with chronic obstructive pulmonary disease.  Thorax. 2004;  59 668-672
  • 78 Baruchin O, Yoffe B, Baruchin A M. Burns in inpatients by simultaneous use of cigarettes and oxygen therapy.  Burns. 2004;  30 836-838
  • 79 Chang T T, Lipinski C A, Sherman H F. A hazard of home oxygen therapy.  J Burn Care Rehabil. 2001;  22 71-74
  • 80 Lacasse Y, LaForge J, Maltais F. Got a match? Home oxygen therapy in current smokers.  Thorax. 2006;  61 374-375
  • 81 Gil T, Metanes I, Har-Shair Y. Mobile phone-triggered thermal burns in the presence of supplemental oxygen.  J Burn Care Res. 2007;  28 348-350
  • 82 Robb B W, Hungness E S, Hershko D D, Warden G D, Kagan R J. Home oxygen therapy: adjunct or risk factor?.  J Burn Care Rehabil. 2003;  24 403-406
  • 83 MacNee W. Oxidative stress and lung inflammation in airways disease.  Eur J Pharmacol. 2001;  429 195-207
  • 84 Repine J E, Bast A, Lankhorst I. Oxidative Stress Study Group . Oxidative stress in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1997;  156(2 Pt 1) 341-357
  • 85 Foschino Barbaro M P, Serviddio G, Resta O et al.. Oxygen therapy at low flow causes oxidative stress in chronic obstructive pulmonary disease: prevention by N-acetyl cysteine.  Free Radic Res. 2005;  39 1111-1118
  • 86 Carpagnano G E, Foschino Barbaro M P, Resta O et al.. Exhaled markers in the monitoring of airways inflammation and its response to steroid's treatment in mild persistent asthma.  Eur J Pharmacol. 2005;  519 175-181
  • 87 Güell Rous R. Long-term oxygen therapy: are we prescribing appropriately?.  Int J Chron Obstruct Pulmon Dis. 2008;  3 231-237
  • 88 Croxton T L, Bailey W C. Long-term oxygen treatment in chronic obstructive pulmonary disease: recommendations for future research: an NHLBI workshop report.  Am J Respir Crit Care Med. 2006;  174 373-378
  • 89 Stoller J K, Panos R J, Krachman S, Doherty D E, Make B. Oxygen therapy for patients with COPD: current evidence and the long-term oxygen treatment trial (LOTT).  Chest. 2010;  , In press

Barry MakeM.D. 

National Jewish Health, 1400 Jackson St.

K729, Denver, CO 80206

Email: makeb@njhealth.org

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