Ambulatory Oxygen in Chronic Obstructive Pulmonary Disease
ABSTRACT
Ambulatory oxygen has been shown to improve pulmonary hemodynamics and reduce dynamic hyperinflation in patients with Chronic Obstructive Pulmonary Disease. Therefore, it is hypothesized to be of benefit in patients with either exertional desaturation or dyspnoea. There is evidence of short-term improvements in exercise distance, exercise time, breathlessness, oxygen saturation and minute ventilation. However, longer term studies only identified improvements in oxygenation and minute ventilation. The benefits were even more limited in patients with no resting hypoxemia. The role in improving exercise training in pulmonary rehabilitation by increasing exercise time and reducing dyspnoea was marginal and no improvements were detected in walking distance or quality of life. Practical considerations make compliance with ambulatory oxygen therapy a major issue with the weight of oxygen and social unacceptability the most often quoted problems. The evidence for any benefit of ambulatory oxygen is therefore limited despite the theoretical benefits.
Ambulatory oxygen has been shown to improve pulmonary hemodynamics and reduce dynamic hyperinflation in patients with Chronic Obstructive Pulmonary Disease. Therefore, it is hypothesized to be of benefit in patients with either exertional desaturation or dyspnoea. There is evidence of short-term improvements in exercise distance, exercise time, breathlessness, oxygen saturation and minute ventilation. However, longer term studies only identified improvements in oxygenation and minute ventilation. The benefits were even more limited in patients with no resting hypoxemia. The role in improving exercise training in pulmonary rehabilitation by increasing exercise time and reducing dyspnoea was marginal and no improvements were detected in walking distance or quality of life. Practical considerations make compliance with ambulatory oxygen therapy a major issue with the weight of oxygen and social unacceptability the most often quoted problems. The evidence for any benefit of ambulatory oxygen is therefore limited despite the theoretical benefits.
KEYWORDS
Ambulatory Oxygen, Pulmonary Rehabilitation, Long-term Oxygen Therapy, Chronic Obstructive Pulmonary Disease (COPD)
Ambulatory Oxygen, Pulmonary Rehabilitation, Long-term Oxygen Therapy, Chronic Obstructive Pulmonary Disease (COPD)
Cite this paper
nullK. Tham and D. Anantham, "Ambulatory Oxygen in Chronic Obstructive Pulmonary Disease," Open Journal of Respiratory Diseases, Vol. 1 No. 2, 2011, pp. 14-18. doi: 10.4236/ojrd.2011.12002.
nullK. Tham and D. Anantham, "Ambulatory Oxygen in Chronic Obstructive Pulmonary Disease," Open Journal of Respiratory Diseases, Vol. 1 No. 2, 2011, pp. 14-18. doi: 10.4236/ojrd.2011.12002.
References
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Winck, “Efficacy and Patterns of Ambulatory Oxygen Usage Experience of A University Hospital,” Revista Portuguesia de Pneumologia, Vol. 17, No. 4, 2011, pp. 159-167. doi:10.1016/j.rppneu.2011.03.012 [19] C. F. McDonald, C. M. Blyth, M. D. Lazarus, I. Mar-schner and C. E. Barter, “Exertional Oxygen of Limited Benefit in Patients with Chronic Obstructive Pulmonary Disease and Mild Hypoxemia,” American Journal of Respiratory & Critical Care Medicine, Vol. 152, No. 5, 1995, pp. 1616-1619. [20] American Thoracic Society/European Respiratory Society Task Force. Standards for the Diagnosis and Management of Patients with COPD [Internet]. Version 1.2. American Thoracic Society, New York, 2004. Available from: http://www.thoracic.org/go/copd [21] National Clinical Guideline Centre. Chronic Obstructive Pulmonary Disease: Management of Chronic Obstructive Pulmonary Disease in Adults in Primary and Secondary Care. National Clinical Guideline Centre, London, 2010. Available from: http://guidance.nice.org.uk/CG101/Guidance/pdf/English [22] K. Stoller, R. Panos, S. Krachman and B. Make, “Oxygen Therapy for Patients with COPD―Current Evidence and the Long-Term Oxygen Treatment Trial,” Chest, Vol. 138, No. 1, 2010, pp. 179-187. [23] A. L. Ries, G. S. Bauldoff, B. W. Carlin, R. Casaburi, C. F. Emery, D. A. Mahler, B. Make, C. L. Rochester, R. Zuwallack and C. Herrerias, “Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines,” Chest, Vol. 135, No. 5, 2007, pp. 4S-42S. doi:10.1378/chest.06-2418 [24] M. L. Nonoyama, D. Brooks, Y. Lacasse, G. H. Guyatt and R. S. Goldstein, “Oxygen Therapy During Exercise Training in Chronic Obstructive Pulmonary Disease,” Cochrane Database Systemic Review, No. 2, Article No. CD005372, 2007. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005372.pub2/abstract [25] K. Wadell, K. Henriksson-Larsén and R. Lundgren, “Physical Training With and Without Oxygen in Patients With Chronic Obstructive Pulmonary Disease and Exercise- Induced Hypoxaemia,” Journal of Rehabilitation Medicine, Vol. 33, No. 5, 2001, pp. 200-205. doi:10.1080/165019701750419581 [26] T. Ringbaek, P. Lange and K. Viskum, “Compliance with LTOT and Consumption of Mobile Oxygen,” Respiratory Medicine, Vol. 93, No. 5, 1999, pp. 333-337. doi:10.1016/S0954-6111(99)90314-1 [27] E. Arnold, A. Bruton, M. Donovan-Hall, A. Fenwick, B. Dibb and E. Walker, “Ambulatory Oxygen: Why Do COPD Patients Not Use Their Portable Systems As Prescribed? A Qualitative Study,” BMC Pulmonary Medicine, Vol. 11, No. 1, 2011, p. 9. doi:10.1186/1471-2466-11-9
[1] Nocturnal Oxygen Therapy Trial Group, “Continuous or Nocturnal Therapy in Hypoxaemic Chronic Obstructive Lung Disease; A Clinical Trial,” Annals of Internal Medicine, Vol. 93, No. 3, 1980, pp. 391-398. [2] Medical Research Council Working Party, “Long Term Domiciliary Oxygen Therapy in Chronic Hypoxic Cor Pulmonale Complicating Chronic Bronchitis and Emphysema,” Lancet, Vol. 1, No. 8222, 1981, pp. 681-686. [3] T. L. Croxton, W. C. Bailey for the NHLBI Working Group on Long-term Oxygen Treatment in COPD, “Long-Term Oxygen Treatment in Chronic Obstructive Pulmonary Disease: Recommendations for Future Research. An NHLBI Workshop Report,” American Journal of Respi-ratory & Critical Care Medicine, Vol. 174, No. 4, 2006, pp. 373-378. doi:10.1164/rccm.200507-1161WS [4] Y. Kawakami, T. Terai, H. Yamamoto and M. Murao, “Exercise and Oxygen Inhalation in Relation to Prognosis of Chronic Obstructive Pulmonary Disease,” Chest, Vol. 81, No. 2, 1982, pp. 182-188. doi:10.1378/chest.81.2.182 [5] N. Takigawa, A. Tada, R. Soda, H. Date, M. Yamashita, S. Endo, S. Takahashi, N. Kawata, T. Shibayama, N. Hamada, M. Sakaguchi, A. Hirano, G. Kimura and C. Okada, K. Takahashi, “Distance and Oxygen Desaturation in 6-Min Walk Test Predict Prognosis in COPD Patients,” Respiratory Medicine, Vol. 101, No. 3, 2007, pp. 561-567. doi:10.1016/j.rmed.2006.06.017 [6] M. B. Drummond, A. L. Blackford, J. O. Benditt, B. J. Make, F. C. Sciurba, M. C. Cormack, F. J. Martinez, H. E. Fessler, A. P. Fishman, R. A. Wise and NETT Investigators, “Continuous Oxygen Use in Nonhypoxemic Emphysema Patients Identifies A High-risk Subset of Patients: Retrospective Analysis of the National Emphysema Treatment Trial,” Chest, Vol. 134, No. 3, 2008, pp. 497-506. doi:10.1378/chest.08-0117 [7] C. Casanova, C. Cote, J. M. Marin, V. Pinto-Plata, J. P. de Torres, A. Aguirre-Jaíme, C. Vassaux and B. R. Celli, “Distance and Oxygen Desaturation During the 6-min Walk Test as Predictors of Long-term Mortality in Patients With COPD,” Chest, Vol. 134, No. 4, 2008, pp. 746-752. doi:10.1378/chest.08-0520 [8] D. A. Stein, B. L. Bradley and W. C. Miller, “Mechanisms of Oxygen Effects on Exercise in Patients With Chronic Obstructive Pulmonary Disease,” Chest, Vol. 81, No. 1, 1982, pp. s6-s10. doi:10.1378/chest.81.1.6 [9] R. Garrod, E. A. Paul and J. A. Wedzicha, “Supplemental Oxygen During Pulmonary Rehabilitation in Patients with COPD with Exercise Hypoxaemia,” Thorax, Vol. 55, No. 7, 2000, pp. 539-543. doi:10.1136/thorax.55.7.539 [10] K. Fujimoto, Y. Matsuzawa, S. Yamaguchi, et al., “Benefits of Oxygen on Exercise Performance and Pulmonary Hemodynamics in Patients with COPD with Mild Hypoxemia,” Chest, Vol. 122, No. 2, 2002, pp. 457-463. doi:10.1378/chest.122.2.457 [11] D. E. O’Donnell, S. M. Revill and K. A. Webb, “Dynamic Hyperinflation and Exercise Intolerance in Chronic Obstructive Pulmonary Disease,” American Journal of Respiratory & Critical Care Medicine, Vol. 164, No. 5, 2001, pp. 770-777. [12] R. P. Moore, D. Berlowitz, L. Denchy, J. Pretto, D. Brazzale, K. Sharpe, B. Jackson and C. A. McDonald “Randomised Trial of Domiciliary, Ambulatory Oxygen in Patients with COPD and Dyspnoea but without Resting Hypoxaemia,” Thorax, Vol. 66, No. 1, 2011, pp. 32-37. doi:10.1136/thx.2009.132522 [13] J. M. Bradley, T. Lasserson, S. Elborn, J. MacMahon and B. A. O’Neill, “Systemic Review of Randomised Controlled Trials Examining the Short-Term Benefit of Ambulatory Oxygen in COPD,” Chest, Vol. 131, No. 1, 2007, pp. 278-285. doi:10.1378/chest.06-0180 [14] S. F. Ram and A. Wedzicha, “Ambulatory Oxygen for Chronic Obstructive Pulmonary Disease,” Cochrane Database of Systemic Reviews, No. 1, Article No. CD000238, 2002. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005372.pub2/abstract [15] A. Somfay, J. Porszasz, S. M. Lee and R. Casaburi, “Doseresponse Effect of Oxygen on Hyperinflation and Exercise Endurance in Nonhypoxaemic COPD Patient,” European Respiratory Journal, Vol. 18, No. 1, 2001, pp. 77-84. doi:10.1183/09031936.01.00082201 [16] T. Eaton, J. E. Garrett, P. Young, W. Fergusson, J. Kolbe, S. Rudkin and K. Whyte, “Ambulatory Oxygen Improves Quality of Life of COPD Patients: A Randomised Controlled Study,” European Respiratory Journal, Vol. 22, No. 2, 2002, pp. 306-312. doi:10.1183/09031936.02.00301002 [17] E. C. Jolly, V. Di Boscio, L. Aguirre, C. M. Luna, S. Berensztein and R. J. Gené, “Effects of Supplemental Oxygen During Activity in Patients with Advanced COPD Without Severe Resting Hypoxemia,” Chest, Vol. 20, No. 2, 2001, 437-443. doi:10.1378/chest.120.2.437 [18] T. Vieira, I. Belchior, J. Almeida, V. Hespanhol and J. C. Winck, “Efficacy and Patterns of Ambulatory Oxygen Usage Experience of A University Hospital,” Revista Portuguesia de Pneumologia, Vol. 17, No. 4, 2011, pp. 159-167. doi:10.1016/j.rppneu.2011.03.012 [19] C. F. McDonald, C. M. Blyth, M. D. Lazarus, I. Mar-schner and C. E. Barter, “Exertional Oxygen of Limited Benefit in Patients with Chronic Obstructive Pulmonary Disease and Mild Hypoxemia,” American Journal of Respiratory & Critical Care Medicine, Vol. 152, No. 5, 1995, pp. 1616-1619. [20] American Thoracic Society/European Respiratory Society Task Force. Standards for the Diagnosis and Management of Patients with COPD [Internet]. Version 1.2. American Thoracic Society, New York, 2004. Available from: http://www.thoracic.org/go/copd [21] National Clinical Guideline Centre. Chronic Obstructive Pulmonary Disease: Management of Chronic Obstructive Pulmonary Disease in Adults in Primary and Secondary Care. National Clinical Guideline Centre, London, 2010. Available from: http://guidance.nice.org.uk/CG101/Guidance/pdf/English [22] K. Stoller, R. Panos, S. Krachman and B. Make, “Oxygen Therapy for Patients with COPD―Current Evidence and the Long-Term Oxygen Treatment Trial,” Chest, Vol. 138, No. 1, 2010, pp. 179-187. [23] A. L. Ries, G. S. Bauldoff, B. W. Carlin, R. Casaburi, C. F. Emery, D. A. Mahler, B. Make, C. L. Rochester, R. Zuwallack and C. Herrerias, “Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines,” Chest, Vol. 135, No. 5, 2007, pp. 4S-42S. doi:10.1378/chest.06-2418 [24] M. L. Nonoyama, D. Brooks, Y. Lacasse, G. H. Guyatt and R. S. Goldstein, “Oxygen Therapy During Exercise Training in Chronic Obstructive Pulmonary Disease,” Cochrane Database Systemic Review, No. 2, Article No. CD005372, 2007. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005372.pub2/abstract [25] K. Wadell, K. Henriksson-Larsén and R. Lundgren, “Physical Training With and Without Oxygen in Patients With Chronic Obstructive Pulmonary Disease and Exercise- Induced Hypoxaemia,” Journal of Rehabilitation Medicine, Vol. 33, No. 5, 2001, pp. 200-205. doi:10.1080/165019701750419581 [26] T. Ringbaek, P. Lange and K. Viskum, “Compliance with LTOT and Consumption of Mobile Oxygen,” Respiratory Medicine, Vol. 93, No. 5, 1999, pp. 333-337. doi:10.1016/S0954-6111(99)90314-1 [27] E. Arnold, A. Bruton, M. Donovan-Hall, A. Fenwick, B. Dibb and E. Walker, “Ambulatory Oxygen: Why Do COPD Patients Not Use Their Portable Systems As Prescribed? A Qualitative Study,” BMC Pulmonary Medicine, Vol. 11, No. 1, 2011, p. 9. doi:10.1186/1471-2466-11-9