Long-term oxygen therapy in COPD patients with moderate hypoxaemia: does it add years to life?

Zieliński, J

doi:10.1183/09031936.98.12040756

Cited by 15 publications

(4 citation statements)

References 27 publications

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“…However, Gorecka et al [25]demonstrated that LTOT did not prolong survival in patients with COPD with moderate hypoxaemia. Referring to the study of Gorecka et al [25], Zielinski [26]pointed out in an editorial that LTOT in these patients ‘does not add any years to life’. He concluded that the important question ‘Does it add life to years?’ remained unanswered.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Oxygen Therapy Stops the Natural Decline of Endurance in COPD Patients with Reversible Hypercapnia

et al. 2004

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Background: Respiratory muscle weakness is one of the most important causes of hypercapnia in patients with COPD. There is evidence that stable hypercapnic patients will benefit from long-term oxygen therapy (LTOT). Objectives: The prognostic role of reversible hypercapnia in COPD is still unclear. Early implementation of LTOT in these patients may influence endurance time and mortality. Methods: In this pilot study, we investigated 28 patients (26 males, 49–74 years) with COPD, advanced airflow limitation [forced expiratory volume in 1 s (percentage of predicted value) 40.8 ± 10.2] and mild hypoxaemia (pO₂ 66.5 ± 6.3 mm Hg). All patients had developed a moderate reversible hypercapnia during an acute exacerbation or during exercise testing (peak pCO₂ 48.0 ± 2.5 mm Hg). Patients were allocated randomly to a control group (n = 14) or an LTOT group (n = 14). The two groups were well matched in terms of physiological data. Lung function, endurance time (cycle ergometer), dyspnoea score, blood gases and LTOT compliance were measured at baseline and every 6 months over a period of 3 years. Results: Endurance time increased from 6.4 ± 2.7 min at baseline to 7.1 ± 2.7 min after 1 year in the LTOT group and decreased from 6.1 ± 3.0 to 4.9 ± 3.8 min in the controls (p < 0.05). After 1 year, the end-exercise dyspnoea score was significantly lower in the LTOT group (4.5 ± 1.5) than in the controls (5.7 ± 1.9). Conclusion: COPD patients with reversible hypercapnia and mild hypoxaemia benefit from LTOT in terms of endurance time and a reduction of exertional dyspnoea after 1 year.

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Section: Discussionmentioning

confidence: 99%

Long-Term Oxygen Therapy Stops the Natural Decline of Endurance in COPD Patients with Reversible Hypercapnia

et al. 2004

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“…El primer fenotipo, y el más antiguo descrito, que cumple con la característica de tener valor predictivo y validarse de manera prospectiva para una consecuencia clínica específi ca, lo constituyen los pacientes con EPOC e insufi ciencia respiratoria crónica 30 , en los cuales el uso de oxígeno domiciliario, por lo menos durante 15 horas diarias, ha mostrado efecto positivo sobre la mortalidad a los 60 meses 31,32 , mientras que esta misma acción no tiene ningún efecto benefi cioso sobre el pronóstico, si se usa en pacientes sin la indicación precisa 33,34 . Un segundo fenotipo, más recientemente descrito, que cumple dichos requisitos, es la respuesta positiva a la cirugía de reducción de volumen, la cual ha mostrado su efi cacia en un subgrupo concreto de pacientes portadores de EPOC, específi camente en aquellos portadores de enfi sema localizado en lóbulos superiores y con mala tolerancia al ejercicio después de un programa de rehabilitación 35 .…”

Section: Características Fenotípicas De La Epocunclassified

Fenotipos clínicos en enfermedad pulmonar obstructiva crónica: ¿volver al futuro?

2012

Rev. méd. Chile

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Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease, that is defi ned by the degree of obstruction rendered by the forced expiratory volume in the fi rst second (FEV 1). El diagnóstico, evaluación y manejo de los pacientes con EPOC constituye un dilema importante, al ser considerada esta enfermedad como una limitación crónica del fl ujo aéreo no completamente reversible, siendo su manejo guiado por la severidad de esta limitación 2 y, por otra parte, reconociendo la EPOC como un síndrome complejo con numerosos componentes pulmonares y extra pulmonares 3 . La EPOC es categorizada, desde el punto de vista gravedad, por un parámetro funcional que mide el volumen espiratorio forzado del primer segundo (VEF 1 ) 2 , el cual no logra capturar la complejidad ni la heterogeneidad de la enfermedad. Se ha intentado caracterizar mejor a estos pacientes, a través de distintos fenotipos 4 , para entender mejor la historia natural, los distintos comportamientos clínicos y las respuestas a las diversas acciones terapéuticas utilizadas.La identifi cación y la agrupación de elementos claves de este verdadero "Síndrome EPOC" en sub-grupos clínicamente signifi cativos (fenotipos clínicos) nos puede permitir entender el dilema recién descrito 5 , y constituye el objetivo principal de esta revisión. Defi niciónUn fenotipo es cualquier característica observable de un organismo 6 , sin embargo, estas

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“…Interestingly, however, we do have some examples that do fulfill this definition. The oldest one probably corresponds to patients with COPD with chronic respiratory failure, in whom a specific type of treatment (domiciliary oxygen therapy) has been shown to improve prognosis below a given arterial PO 2 value (34, 35) but not above it (36,37). A more recent example is lung volume reduction surgery, which has also been shown to improve prognosis in a well-characterized COPD phenotype (upper lobe emphysema and poor exercise capacity after rehabilitation) (38).…”

Section: Genotype and Phenotypes: Avoiding Confusionmentioning

confidence: 99%

Addressing the Complexity of Chronic Obstructive Pulmonary Disease

Agustí

Sobradillo²,

Celli³

2011

Am J Respir Crit Care Med

160

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Chronic obstructive pulmonary disease (COPD) is a complex disease at the clinical, cellular, and molecular levels. However, its diagnosis, assessment, and therapeutic management are based almost exclusively on the severity of airflow limitation. A better understanding of the multiple dimensions of COPD and its relationship to other diseases is very relevant and of high current interest. Recent theoretical (scale-free networks), technological (high-throughput technology, biocomputing), and analytical improvements (systems biology) provide tools capable of addressing the complexity of COPD. The information obtained from the integrated use of those techniques will be eventually incorporated into routine clinical practice. This review summarizes our current knowledge in this area and offers an insight into the elements needed to progress toward an integrated, multilevel view of COPD based on the novel scientific strategy of systems biology and its potential clinical derivative, P4 medicine (Personalized, Predictive, Preventive, and Participatory).

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Long-term oxygen therapy in COPD patients with moderate hypoxaemia: does it add years to life?

Cited by 15 publications

References 27 publications

Long-Term Oxygen Therapy Stops the Natural Decline of Endurance in COPD Patients with Reversible Hypercapnia

Long-Term Oxygen Therapy Stops the Natural Decline of Endurance in COPD Patients with Reversible Hypercapnia

Fenotipos clínicos en enfermedad pulmonar obstructiva crónica: ¿volver al futuro?

Addressing the Complexity of Chronic Obstructive Pulmonary Disease

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