Effects of Prolonged Oxygen Therapy on Pulmonary Hypertension and Blood Viscosity in Patients with Advanced Cor Pulmonale

Głuskowski, J; Jedrzejewska-Makowska, M; Hawryłkiewicz, I; Vertun, B; Zieliński, J

doi:10.1159/000194546

Cited by 18 publications

(5 citation statements)

References 13 publications

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“…Compared with control groups without oxygen a higher survival rate, a reversal of pulmonary hypertension and hence less frequent respiratory and cardiac decom pensations were found [2,4,7,8,11,14]. Although the indication for long-term oxygen therapy is well defined by the de gree of chronic hypoxemia [3,10], there are only a few investigators who tried to analyze in more detail the criteria of pa tients before oxygen therapy in regard to their future course and prognosis.…”

Section: Introductionmentioning

confidence: 99%

Predictors for Early Mortality in Patients with Long-Term Oxygen Home Therapy

Keller¹,

Ragaz²,

Borer³

1985

Respiration

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The follow-up of 87 patients with long-term oxygen therapy over a 3-year period revealed a mortality of 23.7% during the first year, of 37.4% after 2 years and of 45 % after 3 years, respectively. The retrospective analysis of baseline characteristics in order to evaluate the causes for early deaths showed no difference in age, lung function tests nor the degree of respiratory insufficiency documented by serial blood gas analysis between the survivors (n = 61) and the dead (n = 26). However, in the group of early deaths there was a significant increase in pulmonary hypertension (mean pulmonary arterial pressure 40.1 ± 12.0 mm Hg) compared with the survivors, who had only mild hypertension (mean pulmonary arterial pressure 29.4 ± 8.9 mm Hg). In addition there was also a lesser response in pulmonary vasodilation during oxygen breathing in the patients who died within the first 2-year period. We conclude that marked pulmonary hypertension with poor response to oxygen breathing is a major limiting factor in the prognosis of patients with long-term oxygen therapy. In contrast neither severe airway obstruction nor pronounced hypoxemia are related to early mortality and should therefore not be considered as a criterion for rapid deterioration and fatal outcome despite oxygen therapy.

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Section: Introductionmentioning

confidence: 99%

Predictors for Early Mortality in Patients with Long-Term Oxygen Home Therapy

Keller¹,

Ragaz²,

Borer³

1985

Respiration

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“…In COPD-PH patients, Long-term oxygen therapy (LTOT) may have haemodynamic and clinical benefits. The evidence base consists of eight reports (n=596; 72–100% men), including one RCT [ 14 ], two randomised parallel group studies comparing LTOT versus nocturnal oxygen therapy (NOT), and four case series [ 15 – 18 ] ( table 1 ). All patients underwent RHC which documented the presence and severity of baseline PH.…”

Section: Resultsmentioning

confidence: 99%

“…All patients underwent RHC which documented the presence and severity of baseline PH. Most studies report outcome data over longer than 1 year (range 2–6 years), but two studies were <8 weeks in duration [ 15 , 19 ]. Most LTOT studies had an unclear or high risk of bias in at least one domain; only one study had a low risk of bias ( supplementary tables S5 and S6 ) [ 20 ], which limits our confidence in the effects of LTOT in COPD-PH.…”

Section: Resultsmentioning

confidence: 99%

“…The haemodynamic benefit of LTOT varied, with small reductions (3–5 mmHg) in mPAP in four of eight studies [ 15 , 16 , 19 , 21 ], and/or PVR in three [ 19 – 21 ], but no reported change in CO (three studies). Even in the absence of actual improvement in the severity of PH, LTOT may be associated with less progression of PH over time [ 14 , 16 ].…”

Section: Resultsmentioning

confidence: 99%

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Treatment of pulmonary hypertension associated with COPD: a systematic review

et al. 2021

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Chronic obstructive pulmonary disease-associated pulmonary hypertension (COPD-PH) is an increasingly recognised condition which contributes to worsening dyspnea and poor survival in COPD. It is uncertain whether specific treatment of COPD-PH, including use of medications approved for pulmonary arterial hypertension (PAH), improves clinical outcomes. This systematic review and meta-analysis assesses potential benefits and risks of therapeutic options COPD-PH.We searched Medline and Embase for relevant publications until Sep 2020. Articles were screened for studies on treatment of COPD-PH for at least 4 weeks in 10 or more patients. Screening, data extraction, and risk of bias assessment were performed independently in duplicate. When possible, relevant results were pooled using the random effects model.Supplemental long-term O2 therapy (LTOT) mildly reduced mean pulmonary artery pressure (PAP), slowed progression of PH, and reduced mortality, but other clinical or functional benefits were not assessed. Phosphodiesterase type-5 inhibitors significantly improved systolic PAP (pooled treatment effect −5.9 mmHg; 95%CI −10.3, −1.6), but had inconsistent clinical benefits. Calcium-channel blockers and endothelin receptor antagonists had limited hemodynamic, clinical, or survival benefits. Statins had limited clinical benefits despite significantly lowering systolic PAP (pooled treatment effect −4.6 mmHg; 95% CI: −6.3, −2.9).This review supports guideline recommendations for LTOT in hypoxemic COPD-PH patients as well as recommendations against treatment with PAH-targeted medications, Effective treatment of COPD-PH depends upon research into the pathobiology, and future high-quality studies comprehensively assessing clinically relevant outcomes are needed.

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“…The benefit of LTOT was more pronounced in the subgroup of patients with FEV 1 higher than 30% of predicted but the difference in survival disappeared abruptly at then years of treatment. At the moment there is few data to support the presumption that LTOT may influence the decline of FEV 1 [44,45] and that FEV 1 may be used to screen patient candidates for LTOT [5,46,47]. Considering the frequent comorbidities associated with COPD patients and the emerging role of FEV 1 as an independent predictor of all-causes mortality [48] and as a strong risk factor for cardiovascular disease, stroke [49,50], the effects of LTOT on COPD-specific end-point such as FEV 1 appears meaningless.…”

Section: Fev 1 (Forced Expiratory Volume In 1 Second)mentioning

confidence: 99%

Long-Term Oxygen Therapy in COPD: evidences and open questions of current indications

Corrado

Renda

Bertini

2016

Monaldi Arch Chest Dis

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Long term oxygen therapy (LTOT) has been shown to improve the survival rate in Chronic Obstructive Pulmonary Disease (COPD) patients with severe resting hypoxemia by NOTT and MRC studies, published more than 25 years ago. The improved survival was found in patients who received oxygen for more than 15 hours/day. The effectiveness of LTOT has been documented only in stable COPD patients with severe chronic hypoxemia at rest (PaO2 < 55 mmHg (7.3 kPa) or PaO2 ranging from 56 to 59 mmHg (7.4-7.8 kPa) in presence of signs of Cor Pulmonale, hematocrit > 55%. In fact no evidence supports the use of LTOT in COPD patients with moderate hypoxemia (55 < PaO2 < 65 mmHg), and in those with decreased oxygen saturation (SO 2 <90%) during exercise or sleep. Furthermore, it is generally accepted without evidence that LTOT in clinical practice is warranted in other forms of chronic respiratory failure not due to COPD when a-terial blood gas criteria match those established for COPD patients. The prescription of oxygen in these circumstances, as for unstable patients, increases the number of patients receiving supplemental oxygen and the related costs. Comorbidities are likely to affect both prognosis and health outcomes in COPD patients, but at the moment we do not know if LTOT in these patients with complex chronic diseases and mild-moderate hypoxemia could be of any use. For these reasons a critical revision of the actual guide lines indications for LTOT in order to optimise effectiveness and costs, and future research in the areas that have not previously been addressed by NOTT and MRC studies, are mandatory.

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Effects of Prolonged Oxygen Therapy on Pulmonary Hypertension and Blood Viscosity in Patients with Advanced Cor Pulmonale

Cited by 18 publications

References 13 publications

Predictors for Early Mortality in Patients with Long-Term Oxygen Home Therapy

Predictors for Early Mortality in Patients with Long-Term Oxygen Home Therapy

Treatment of pulmonary hypertension associated with COPD: a systematic review

Long-Term Oxygen Therapy in COPD: evidences and open questions of current indications

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