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Original article
A randomised trial of domiciliary, ambulatory oxygen in patients with COPD and dyspnoea but without resting hypoxaemia
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  1. Rosemary P Moore1,2,3,4,5,
  2. David J Berlowitz1,2,3,4,5,
  3. Linda Denehy4,
  4. Jeffrey J Pretto1,6,
  5. Danny J Brazzale1,2,
  6. Ken Sharpe7,
  7. Bruce Jackson8,
  8. Christine F McDonald1,2,5
  1. 1Institute for Breathing and Sleep, Austin Hospital, Heidelberg, Victoria, Australia
  2. 2Department of Respiratory and Sleep Medicine, Austin Hospital, Heidelberg, Victoria, Australia
  3. 3The Northern Clinical Research Centre, The Northern Hospital, Epping, Victoria, Australia
  4. 4Melbourne Physiotherapy School, The University of Melbourne, Parkville, Victoria, Australia
  5. 5Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
  6. 6Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
  7. 7Department of Mathematics and Statistics, The University of Melbourne, Victoria, Australia
  8. 8Vascular Medicine Unit, Dandenong Hospital, Dandenong, Victoria, Australia
  1. Correspondence to Professor Christine F McDonald, Department of Respiratory and Sleep Medicine, Level One Harold Stokes Building, Austin Hospital, Studley Road, Heidelberg, Victoria 3084, Australia; christine.mcdonald{at}austin.org.au

Abstract

Background Patients with chronic obstructive pulmonary disease (COPD) who are not severely hypoxaemic at rest may experience significant breathlessness on exertion, and ambulatory oxygen is often prescribed in this circumstance despite a lack of conclusive evidence for benefit. This study aimed to determine whether such patients benefit from domiciliary ambulatory oxygen and, if so, which factors may be associated with benefit.

Methods This was a 12 week, parallel, double-blinded, randomised, placebo-controlled trial of cylinder air versus cylinder oxygen, provided at 6 l/min intranasally, for use during any activity provoking breathlessness. Patients underwent baseline measurements of arterial blood gases and lung function. Outcome measures assessed dyspnoea, health-related quality of life, mood disturbance, functional status and cylinder utilisation. Data were analysed on an intention-to-treat basis, p≤0.05.

Results 143 subjects (44 female), mean±SD age 71.8±9.8 years, forced expiratory volume in 1 s (FEV1)1.16±0.51 lites, Pao2 9.5±1.1 kPa (71.4±8.5 mm Hg) were randomised, including 50 patients with exertional desaturation to ≤88%. No significant differences in any outcome were found between groups receiving air or oxygen. Statistically significant but clinically small improvements in dyspnoea and depression were observed in the whole study group over the 12 weeks of the study.

Conclusion In breathless patients with COPD who do not have severe resting hypoxaemia, domiciliary ambulatory oxygen confers no benefits in terms of dyspnoea, quality of life or function. Exertional desaturation is not predictive of outcome. Intranasal gas (either air or oxygen) may provide a placebo benefit.

Clinical trial number ACTRN12605000457640.

  • Oxygen therapy
  • chronic obstructive pulmonary disease
  • ambulatory oxygen
  • ambulatory oxygen therapy

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Supplementary materials

  • Web Only Data THX.2009.132522

    Files in this Data Supplement:

Footnotes

  • Funding National Health and Medical Research Council, Northern Clinical Research Centre, Victorian Tuberculosis and Lung Association, Austin Hospital Medical Research Foundation, Institute for Breathing and Sleep, Austin Hospital, Australia Finkel Foundation, Air Liquide, Boehringer Ingelheim.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Austin Hospital Medical Research Ethics Committee and the Northern Hospital Medical Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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