Limits...
Long-term oxygen therapy: are we prescribing appropriately?

Güell Rous R - Int J Chron Obstruct Pulmon Dis (2008)

Bottom Line: It also appears to reduce the number of hospitalizations, increase effort capacity, and improve health-related quality of life.The benefits of LTOT depend on correction of hypoxemia.During sleep, continuous monitoring of SaO2 and PaCO2 should be performed to confirm correction of SaO2 overnight.

View Article: PubMed Central - PubMed

Affiliation: Departament de Pneumologia, Hospital de la Santa Creu I de Sant Pau, Barcelona, Spain. mguellr@santpau.es

ABSTRACT
Long-term oxygen therapy (LTOT) is the treatment proven to improve survival in chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure. It also appears to reduce the number of hospitalizations, increase effort capacity, and improve health-related quality of life. Standard LTOT criteria are related to COPD patients who have PaO2 < 60 mmHg, are in a clinical stable situation, and are receiving optimal pharmacological treatment. According to LTOT guidelines, oxygen should be prescribed for at least 18 hours per day although some authors consider 24 hours would be more beneficial. The benefits of LTOT depend on correction of hypoxemia. Arterial blood gases should be measured at rest. During exercise, an effort test should be done to assure adequate SaO2. During sleep, continuous monitoring of SaO2 and PaCO2 should be performed to confirm correction of SaO2 overnight. An arterial blood gas sample should be taken at awakening to assess PaCO, in order to prevent hypoventilation from the oxygen therapy. Several issues that need to be addressed are the use of LTOT in COPD patients with moderate hypoxemia, the efficacy of LTOT in patients who desaturate during exercise or during sleep, the optimal dosage of oxygen supplementation, LTOT compliance, and the LTOT prescription in diseases other than COPD.

Show MeSH

Related in: MedlinePlus

Comparison of survival curves of NOTT and MRC studies. The poorest prognosis was in the MRC controls who received no oxygen. The best survival was in the NOTT patients who received oxygen for >19 hours/day. Copyright © 1980, 1981. Modified with permission from [NOTT] Nocturnal Oxygen Therapy Trial Group. 1980. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group. Ann Inter Med, 93:391–8; [MRC] Medical Research Council Working Party. 1981. Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Report of the Medical Research Council Working Party. Lancet, 1:681–5.Abbreviations: MRC, Medical Research Council; NIH, National Institutes of Health; NOTT, Nocturnal Oxygen Therapy Trial.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2629963&req=5

f1-copd-3-231: Comparison of survival curves of NOTT and MRC studies. The poorest prognosis was in the MRC controls who received no oxygen. The best survival was in the NOTT patients who received oxygen for >19 hours/day. Copyright © 1980, 1981. Modified with permission from [NOTT] Nocturnal Oxygen Therapy Trial Group. 1980. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group. Ann Inter Med, 93:391–8; [MRC] Medical Research Council Working Party. 1981. Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Report of the Medical Research Council Working Party. Lancet, 1:681–5.Abbreviations: MRC, Medical Research Council; NIH, National Institutes of Health; NOTT, Nocturnal Oxygen Therapy Trial.

Mentions: Early reports on respiratory failure in patients with chronic obstructive pulmonary disease (COPD) suggested that oxygen therapy decreases pulmonary hypertension and red cell mass while simultaneously increasing exercise capacity (O’Donohue 1995) In the 1980s, two landmark multicentre trials, the Nocturnal Oxygen Therapy Trial (NOTT) (NOTT 1980) and the Medical Research Council (MRC) (MRC 1981) study, showed that long-term oxygen therapy (LTOT) was the sole treatment that improved survival in patients with COPD and chronic respiratory failure (CRF), and that these patients received oxygen for at least 18 hours/day (Figure 1). These findings were reaffirmed in later trials (Dubois et al 1994; Zielinski et al 1998). NOTT (1980) and MRC (1981) trials led to the establishment of criteria for oxygen therapy in almost every country in the developed world (Table 1) (Sanchez-Agudo et al 1998; ATS 1995; Siafakas et al 1995; Celli et al 2004; Rabe et al 2007). There is also evidence that LTOT has benefits other than survival. These include stabilization of pulmonary arterial hypertension, fewer cardiac arrhythmias and electrocardiographic findings suggestive of myocardial ischemia, increased exercise capacity, an improvement in neuropsychiatric function and in health-related quality of life, and a reduction of exacerbations or hospitalizations (Tirlapur and Mir 1982; Davidson et al 1988; Morrison and Stovall 1992; Dean et al 1992; Clini et al 1996; Wedzicha 2000; Ringbaek et al 2002; Eaton et al 2004). However, these clinical benefits depend on treatment compliance, the duration of the treatment, and adequate correction of hypoxemia (Gorecka et al 1992; Sliwinski et al 1994; Pepin et al 1996; Plywaczewski et al 2000; Criner 2000; Tárrega et al 2002).


Long-term oxygen therapy: are we prescribing appropriately?

Güell Rous R - Int J Chron Obstruct Pulmon Dis (2008)

Comparison of survival curves of NOTT and MRC studies. The poorest prognosis was in the MRC controls who received no oxygen. The best survival was in the NOTT patients who received oxygen for >19 hours/day. Copyright © 1980, 1981. Modified with permission from [NOTT] Nocturnal Oxygen Therapy Trial Group. 1980. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group. Ann Inter Med, 93:391–8; [MRC] Medical Research Council Working Party. 1981. Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Report of the Medical Research Council Working Party. Lancet, 1:681–5.Abbreviations: MRC, Medical Research Council; NIH, National Institutes of Health; NOTT, Nocturnal Oxygen Therapy Trial.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2629963&req=5

f1-copd-3-231: Comparison of survival curves of NOTT and MRC studies. The poorest prognosis was in the MRC controls who received no oxygen. The best survival was in the NOTT patients who received oxygen for >19 hours/day. Copyright © 1980, 1981. Modified with permission from [NOTT] Nocturnal Oxygen Therapy Trial Group. 1980. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group. Ann Inter Med, 93:391–8; [MRC] Medical Research Council Working Party. 1981. Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Report of the Medical Research Council Working Party. Lancet, 1:681–5.Abbreviations: MRC, Medical Research Council; NIH, National Institutes of Health; NOTT, Nocturnal Oxygen Therapy Trial.
Mentions: Early reports on respiratory failure in patients with chronic obstructive pulmonary disease (COPD) suggested that oxygen therapy decreases pulmonary hypertension and red cell mass while simultaneously increasing exercise capacity (O’Donohue 1995) In the 1980s, two landmark multicentre trials, the Nocturnal Oxygen Therapy Trial (NOTT) (NOTT 1980) and the Medical Research Council (MRC) (MRC 1981) study, showed that long-term oxygen therapy (LTOT) was the sole treatment that improved survival in patients with COPD and chronic respiratory failure (CRF), and that these patients received oxygen for at least 18 hours/day (Figure 1). These findings were reaffirmed in later trials (Dubois et al 1994; Zielinski et al 1998). NOTT (1980) and MRC (1981) trials led to the establishment of criteria for oxygen therapy in almost every country in the developed world (Table 1) (Sanchez-Agudo et al 1998; ATS 1995; Siafakas et al 1995; Celli et al 2004; Rabe et al 2007). There is also evidence that LTOT has benefits other than survival. These include stabilization of pulmonary arterial hypertension, fewer cardiac arrhythmias and electrocardiographic findings suggestive of myocardial ischemia, increased exercise capacity, an improvement in neuropsychiatric function and in health-related quality of life, and a reduction of exacerbations or hospitalizations (Tirlapur and Mir 1982; Davidson et al 1988; Morrison and Stovall 1992; Dean et al 1992; Clini et al 1996; Wedzicha 2000; Ringbaek et al 2002; Eaton et al 2004). However, these clinical benefits depend on treatment compliance, the duration of the treatment, and adequate correction of hypoxemia (Gorecka et al 1992; Sliwinski et al 1994; Pepin et al 1996; Plywaczewski et al 2000; Criner 2000; Tárrega et al 2002).

Bottom Line: It also appears to reduce the number of hospitalizations, increase effort capacity, and improve health-related quality of life.The benefits of LTOT depend on correction of hypoxemia.During sleep, continuous monitoring of SaO2 and PaCO2 should be performed to confirm correction of SaO2 overnight.

View Article: PubMed Central - PubMed

Affiliation: Departament de Pneumologia, Hospital de la Santa Creu I de Sant Pau, Barcelona, Spain. mguellr@santpau.es

ABSTRACT
Long-term oxygen therapy (LTOT) is the treatment proven to improve survival in chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure. It also appears to reduce the number of hospitalizations, increase effort capacity, and improve health-related quality of life. Standard LTOT criteria are related to COPD patients who have PaO2 < 60 mmHg, are in a clinical stable situation, and are receiving optimal pharmacological treatment. According to LTOT guidelines, oxygen should be prescribed for at least 18 hours per day although some authors consider 24 hours would be more beneficial. The benefits of LTOT depend on correction of hypoxemia. Arterial blood gases should be measured at rest. During exercise, an effort test should be done to assure adequate SaO2. During sleep, continuous monitoring of SaO2 and PaCO2 should be performed to confirm correction of SaO2 overnight. An arterial blood gas sample should be taken at awakening to assess PaCO, in order to prevent hypoventilation from the oxygen therapy. Several issues that need to be addressed are the use of LTOT in COPD patients with moderate hypoxemia, the efficacy of LTOT in patients who desaturate during exercise or during sleep, the optimal dosage of oxygen supplementation, LTOT compliance, and the LTOT prescription in diseases other than COPD.

Show MeSH
Related in: MedlinePlus