Thorax 2000;55:539-543 ( July )

Supplemental oxygen during pulmonary rehabilitation in patients with COPD with exercise hypoxaemia

R Garrod, E A Paul, J A Wedzicha

Academic Respiratory Medicine, St Bartholomew's and Royal London Schools of Medicine and Dentistry and London Chest Hospital, London, UK

Correspondence to: Dr J A Wedzicha, Academic Respiratory Medicine, Dominion House, St Bartholomew's Hospital, London EC1A 7BE, UK email: J.A.Wedzicha{at}mds.ac.uk

Received 18 June 1999; Returned to authors 18 October 1999; Revised version received 19 January 2000; Accepted for publication 22 February 2000

BACKGROUNDSupplemental oxygen in patients with chronic obstructive pulmonary disease (COPD) and exercise hypoxaemia improves exercise capacity and dyspnoea. However, the benefit of oxygen during pulmonary rehabilitation in these patients is still unknown.
METHODSTwenty five patients with stable COPD (mean (SD) forced expiratory volume in one second (FEV₁) 0.76 (0.29) l and 30.0 (9.89)% predicted, arterial oxygen tension (PaO₂) 8.46 (1.22) kPa, arterial carbon dioxide tension (PaCO₂) 6.32 (1.01) kPa) and significant arterial desaturation on exercise (82.0 (10.4)%) were entered onto a pulmonary rehabilitation programme. Patients were randomised to train whilst breathing oxygen (OT) (n = 13) or air (AT) (n = 12), both at 4 l/min. Assessments included exercise tolerance and associated dyspnoea using the shuttle walk test (SWT) and Borg dyspnoea score, health status, mood state, and performance during daily activities.
RESULTSThe OT group showed a significant reduction in dyspnoea after rehabilitation compared with the AT group (Borg mean difference -1.46 (95% CI -2.72 to -0.19)) but there were no differences in other outcome measures: SWT difference -23.6 m (95% CI -70.7 to 23.5), Chronic Respiratory Disease Questionnaire 3.67 (95% CI -7.70 to 15.1), Hospital Anxiety and Depression Scale 1.73 (95% CI -2.32 to 5.78), and London Chest Activity of Daily Living Scale -2.18 (95% CI -7.15 to 2.79). At baseline oxygen significantly improved SWT (mean difference 27.3 m (95% CI 14.7 to 39.8) and dyspnoea (-0.68 (95% CI -1.05 to -0.31)) compared with placebo air.
CONCLUSIONSThis study suggests that supplemental oxygen during training does little to enhance exercise tolerance although there is a small benefit in terms of dyspnoea. Patients with severe disabling dyspnoea may find symptomatic relief with supplemental oxygen.


Keywords: chronic obstructive pulmonary disease; exercise induced dyspnoea; rehabilitation; oxygen

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© 2000 by Thorax
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