Exercise and Oxygen Inhalation in Relation to Prognosis of Chronic Obstructive Pulmonary Disease

Kawakami, Yoshikazu; Terai, Tsugio; Yamamoto, Hiroshi; Murao, Makoto

doi:10.1378/chest.81.2.182

Cited by 29 publications

(15 citation statements)

References 18 publications

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“…10,[20][21][22][23] In a retrospective review of 144 patients, Takigawa and coworkers 21 showed that a fall in Sp o 2 Ն 6% during a 6-min walk predicted mortality. Similarly, in a prospective study of 576 patients with stable COPD, Casanova and colleagues 22 demonstrated that desaturation (a decrease in the Sp o 2 Ն 4% daily activities compared with room air.…”

Section: Mortalitymentioning

confidence: 99%

Oxygen Therapy for Patients With COPD

Stoller

Panos²,

Krachman

et al. 2010

Chest

165

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Use of supplemental long-term oxygen therapy (LTOT) by patients with COPD is common, with more than 1 million Medicare recipients using oxygen at an annual cost of more than $2 billion. 1,2 Although current indications for LTOT are based on the results of older randomized trials, 3,4 a recent conference identifi ed uncertainties regarding LTOT in COPD, including its effi cacy in patients with more moderate hypoxemia. 1 This article reviews the available evidence regarding the effi cacy of LTOT for individuals with COPD Long-term use of supplemental oxygen improves survival in patients with COPD and severe resting hypoxemia. However, the role of oxygen in symptomatic patients with COPD and more moderate hypoxemia at rest and desaturation with activity is unclear. The few long-term reports of supplemental oxygen in this group have been of small size and insuffi cient to demonstrate a survival benefi t. Short-term trials have suggested benefi cial effects other than survival in patients with COPD and moderate hypoxemia at rest. In addition, supplemental oxygen appeared to improve exercise performance in small short-term investigations of patients with COPD and moderate hypoxemia at rest and desaturation with exercise, but long-term trials evaluating patient-reported outcomes are lacking. This article reviews the evidence for long-term use of supplemental oxygen therapy and provides a rationale for the National Heart, Lung, and Blood Institute Long-term Oxygen Treatment Trial. The trial plans to enroll subjects with COPD with moderate hypoxemia at rest or desaturation with exercise and compare tailored oxygen therapy to no oxygen therapy.

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Section: Mortalitymentioning

confidence: 99%

Oxygen Therapy for Patients With COPD

Stoller

Panos²,

Krachman

et al. 2010

Chest

165

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“…However, some patients do not meet these criteria during rest, but significant oxygen desaturation occurs during exertion [12]. Earlier studies have suggested that deterioration of Sp o 2 during physical exercise is associated with increased risk of mortality in patients with COPD [13,14]. Nonetheless, exercise-induced desaturation (EID) remains a topic of interest and prediction of EID could be useful for the clinical management of COPD patients to ensure maintenance of normoxemia during physical activity and elude potential adverse consequences of hypoxemia.…”

Section: Introductionmentioning

confidence: 99%

“…These studies reported contradicting findings as to whether pulmonary function parameters, such as forced expiratory volume in one second (FEV 1 ) and diffusion capacity for carbon monoxide (D l c o ) as well as resting Sp o 2 , can predict EID. Some of these studies found that FEV 1 , D l c o and resting Sp o 2 can be used as screening tests to predict EID [12,13,19,20], but others failed to identify those or other variables as predictors [5,15,18]. …”

Section: Introductionmentioning

confidence: 99%

Prevalence and Prediction of Exercise-Induced Oxygen Desaturation in Patients with Chronic Obstructive Pulmonary Disease

Gestel¹,

Clarenbach

Stöwhas

et al. 2012

Respiration

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Background: Previous studies with small sample sizes reported contradicting findings as to whether pulmonary function tests can predict exercise-induced oxygen desaturation (EID). Objective: To evaluate whether forced expiratory volume in one second (FEV₁), resting oxygen saturation (Spo₂) and diffusion capacity for carbon monoxide (Dlco) are predictors of EID in chronic obstructive pulmonary disease (COPD). Methods: We measured FEV₁, Dlco, Spo₂ at rest and during a 6-min walking test as well as physical activity by an accelerometer. A drop in Spo₂ of >4 to <90% was defined as EID. To evaluate associations between measures of lung function and EID univariate and multivariate analyses were used and positive/negative predictive values were calculated. Receiver operating characteristic curve analysis was performed to determine the most useful threshold in order to predict/exclude EID. Results: We included 154 patients with COPD (87 females). The mean FEV₁ was 43.0% (19.2) predicted and the prevalence of EID was 61.7%. The only independent predictor of EID was FEV₁ and the optimal cutoff value of FEV₁ was at 50% predicted (area under ROC curve, 0.85; p < 0.001). The positive predictive value of a threshold of FEV₁ <50% was 0.83 with a likelihood ratio of 3.03 and the negative predicting value of a threshold of FEV₁ ≥80% was 1.0. The severity of EID was correlated with daily physical activity (r = –0.31, p = 0.008). Conclusions: EID is highly prevalent among patients with COPD and can be predicted by FEV₁. EID seems to be associated with impaired daily physical activity which supports its clinical importance.

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“…A limited number of studies, comprised of small patient numbers, suggest that transient exertional desaturation may be associated with increased mortality. [39][40][41][42] This has some biologic plausibility, since exercise-induced desaturation has been previously shown to correlate with the severity of pulmonary vascular disease in patients with only mild-moderate resting hypoxemia. 43 However, limited information exists as to whether supplemental oxygen alters the course of the disease or prolongs survival.…”

Section: Exercisementioning

confidence: 95%

Ambulatory Home Oxygen: What Is the Evidence for Benefit, and Who Does It Help?

Criner

2012

Respir Care

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The beneficial effects of ambulatory home oxygen have been demonstrated since the 1950s, when Cotes and Gibson gave oxygen to ambulatory COPD patients from small portable high pressures cylinders in the United Kingdom. Over the ensuing 7 decades, oxygen has been prescribed to millions of COPD patients in the home setting. Additionally, it is common clinical practice to prescribe supplemental oxygen when chronic hypoxemic respiratory failure not due to COPD (eg, interstitial lung disease, pulmonary hypertension, kyphoscoliosis, and cystic fibrosis) is present or in patients with hypoxemia at hospital discharge following flares of their underlying chronic respiratory disorder, without any substantial evidence. Despite the importance of long-term oxygen therapy in clinical home management, there are many gaps in our current knowledge regarding its mechanisms of action, indications for prescription, and its effects on important patient outcomes. Research conducted in the 1970s and 1980s still provides the basis for clinical decision making and insurance coverage policies regarding long-term oxygen administration. Remarkably, little current research is being conducted to extend our knowledge regarding the indications, mechanisms, and benefits of long-term oxygen therapy. This review will focus on our current knowledge of the end points for supplemental oxygen at home, such as mortality, effects on functional performance, sensation of dyspnea, cognitive function, and quality of life, and highlight areas where future research is needed.

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Exercise and Oxygen Inhalation in Relation to Prognosis of Chronic Obstructive Pulmonary Disease

Cited by 29 publications

References 18 publications

Oxygen Therapy for Patients With COPD

Oxygen Therapy for Patients With COPD

Prevalence and Prediction of Exercise-Induced Oxygen Desaturation in Patients with Chronic Obstructive Pulmonary Disease

Ambulatory Home Oxygen: What Is the Evidence for Benefit, and Who Does It Help?

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