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A Systematic Review of Randomized Controlled Trials Examining the Short-term Benefit of Ambulatory Oxygen in COPD

      Abstract

      Aim:To systematically review the short-term efficacy of ambulatory oxygen from single-assessment studies in COPD.
      Methods:Searches for relevant randomized controlled trials using predefined search terms were conducted on the Cochrane Airways Group Specialized Register of RCTs, the Cochrane Central Register of Controlled Trials, and other electronically available journals, databases, and search engines. All databases were searched from their inception until December 2004. Two reviewers (J.B., B.O.) independently assessed eligibility and extracted data. All trial data were combined using RevMan analyses 4.2.8 (Cochrane Collaboration;). Due to the crossover design of the studies, data were entered using the generic inverse variance method. Fixed-effect or random-effect models were used depending on the level of statistical heterogeneity observed.
      Results:Thirty-one studies (33 data sets; 534 participants) met the inclusion criteria of the review. Oxygen improved the primary outcomes relating to endurance and maximal exercise capacity. For the secondary outcomes of breathlessness, arterial oxygen saturation (Sao2), and minute ventilation (Ve), comparisons were made at isotime. Oxygen improved breathlessness, Sao2/Pao2, and Veat isotime with endurance exercise testing. For maximal exercise testing, data were not available in a format suitable for metaanalysis for breathlessness, but the improvement in Sao2/Pao2and Veat isotime was significant.
      Conclusion:This review provides evidence from single-assessment studies that ambulatory oxygen improves exercise performance in COPD; however, the clinical importance of this size of improvement is unclear. Prior to widespread prescription of ambulatory oxygen, future research is required to establish the net long-term benefit of ambulatory oxygen in patients with different levels of hypoxemia or exercise-induced desaturation.

      Key words

      ABBREVIATION:

      CI (confidence interval), QUOROM (Quality of Reporting of Meta-analysis), RCT (randomized controlled trial), Sao2 (arterial oxygen saturation), Ve (minute ventilation)
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      References

        • Clinical component for the home oxygen service in England and Wales. British Thoracic Society (BTS) working group on home oxygen services, January 2006.
        (Available at:) (Accessed January 1)
      1. Domiciliary oxygen therapy services: clinical guidelines and advice for prescribers; a report of the Royal College of Physicians June 1999

        • Ram FSF
        • Wedzicha JA
        Ambulatory oxygen for chronic obstructive pulmonary disease.
        Cochrane Database Syst Rev. 2002; : CD000238
        • Agence d'evaluation des technologies et des modes d'intervention en sante (AETMIS).
        Hospital technology at home: portable oxygen therapy in COPD; report prepared by Susan Law and Pascale Lehoux. 2004; (AETMIS. Montreal, Canada:)
        • Young P
        Ambulatory and training oxygen: a review of the evidence and guidelines for prescription.
        N Z J Physiother. 2005; 33: 7-12
        • Bradley JM
        • O'Neill B
        Short-term ambulatory oxygen for chronic obstructive pulmonary disease.
        Cochrane Database Syst Rev. 2005; : CD004356
        • Moher D
        • Cook DJ
        • Eastwood S
        • et al.
        Improving the quality of reports of meta-analysis of randomized controlled trials: the QUOROM statement; quality of reporting of meta-analysis.
        Lancet. 1999; 354: 1896-1900
        • PEDro physiotherapy evidence database.
        (Available at:) (Accessed July 15)
        • Fujimoto K
        • Matsuzawa Y
        • Yamaguchi S
        • et al.
        Benefits of oxygen on exercise performance and pulmonary hemodynamics in patients with COPD with mild hypoxemia.
        Chest. 2002; 122: 457-463
        • Criner GJ
        • Celli BR
        Ventilatory muscle recruitment in exercise with O2in obstructed patients with mild hypoxemia.
        J Appl Physiol. 1987; 63: 195-200
        • Eaton T
        • Garrett JE
        • Young W
        • et al.
        Ambulatory oxygen improves quality of life of COPD patients: a randomised controlled study.
        Eur Respir J. 2002; 20: 306-312
        • Garrod R
        • Bestall JC
        • Paul E
        • et al.
        Evaluation of pulsed dose oxygen delivery during exercise in patients with severe chronic obstructive pulmonary disease.
        Thorax. 1999; 54: 242-244
        • Garrod R
        • Paul EA
        • Wedzicha JA
        Supplemental oxygen therapy during pulmonary rehabilitation in patients with COPD and exercise hypoxaemia.
        Thorax. 2000; 55: 539-543
        • Ishimine A
        • Saito T
        • Nishimura S
        • et al.
        The effect of oxygen supplementation during exercise in COPD patients with Pao2over 60 Torr.
        Jpn J Chest Dis. 1995; 33: 510-518
        • King AJ
        • Cooke NJ
        • Leitch AG
        • et al.
        The effects of 30% oxygen on the respiratory response to treadmill exercise in chronic respiratory failure.
        Clin Sci. 1973; 44: 151-162
        • Kurihara N
        • Fujimoto S
        • Kouno
        • et al.
        Exercise induced hypoxemia and exercise tolerance in patients with COPD and the benefits of oxygen supplementation.
        Jpn J Chest Dis. 1989; 26: 155-162
        • Leach RM
        • Davidson AC
        • Chinn S
        • et al.
        Portable liquid oxygen and exercise ability in severe respiratory disability.
        Thorax. 1992; 47: 781-789
        • Leggett RJE
        • Flenley DC
        Portable oxygen and exercise tolerance in patients with chronic hypoxic cor pulmonale.
        BMJ. 1977; 2: 84-86
        • Light RW
        • Mahutte CK
        • Stansbury DW
        • et al.
        Relationship between improvement in exercise performance with supplemental oxygen and hypoxic ventilatory drive in patients with chronic airflow obstruction.
        Chest. 1989; 95: 751-756
        • Mannix ET
        • Manfredi F
        • Palange P
        • et al.
        Oxygen may lower the O2cost of ventilation in chronic obstructive lung disease.
        Chest. 1992; 101: 910-915
        • McDonald CF
        • Blyth CM
        • Lazarus MD
        • et al.
        Exertional oxygen of limited benefit in patients with chronic obstructive pulmonary disease and mild hypoxemia.
        Am J Respir Crit Care Med. 1995; 152: 1616-1619
        • McKeon JL
        • Tarrant EP
        • Tomlinson JC
        • et al.
        Portable oxygen in patients with severe chronic obstructive pulmonary disease.
        Aust N Z J Med. 1988; 18: 125-129
        • Raimondi AC
        • Edwards RHT
        • Denison DM
        • et al.
        Exercise tolerance breathing a low density gas mixture, 35% oxygen and air in patients with chronic obstructive bronchitis.
        Clin Sci. 1970; 39: 675-685
        • Stein DA
        • Bradley BL
        • Miller WC
        Mechanisms of oxygen effects on exercise in patients with chronic obstructive pulmonary disease.
        Chest. 1982; 81: 6-10
        • Woodcock AA
        • Gross ER
        • Geddes DM
        Oxygen relieves breathlessness in “pink puffers.”.
        Lancet. 1981; 1: 907-909
        • Gosselin N
        • Durand F
        • Poulain M
        • et al.
        Effect of acute hyperoxia during exercise on quadriceps electrical activity in active COPD patients.
        Acta Physiol Scand. 2004; 181: 333-343
        • Knebel AR
        • Bentz E
        • Barnes P
        Dyspnea management in A-1 antitrypsin deficiency: effect of oxygen administration.
        Nurs Res. 2000; 46: 333-338
        • Palange P
        • Galassetti P
        • Mannix ET
        • et al.
        Oxygen effect on O2deficit and VO2kinetics during exercise in obstructive pulmonary disease.
        J Appl Physiol. 1995; 78: 2228-2234
        • Bradley BL
        • Garner AE
        • Billiu D
        • et al.
        Oxygen-assisted exercise in chronic obstructive lung disease.
        Am Rev Respir Dis. 1978; 118: 239-243
        • Bye PT
        • Esau SA
        • Levy RD
        • et al.
        Ventilatory muscle function during exercise in air and oxygen in patients with chronic air-flow limitation.
        Am Rev Respir Dis. 1985; 132: 236-240
        • Dean NC
        • Brown JK
        • Himelman RB
        • et al.
        Oxygen may improve dyspnea and endurance in patients with chronic obstructive pulmonary disease and only mild hypoxemia.
        Am Rev Respir Dis. 1992; 146: 941-945
        • O'Donnell DE
        • Bain DJ
        • Webb KA
        Factors contributing to relief of exertional breathlessness during hyperoxia in chronic airflow limitation.
        Am J Respir Crit Care Med. 1997; 155: 530-535
        • O'Donnell DE
        • D'Arsigny C
        • Webb KA
        Effects of hyperoxia on ventilatory limitation during exercise in advanced chronic obstructive pulmonary disease.
        Am J Respir Crit Care Med. 2001; 163: 892-898
        • Swinburn CR
        • Wakefield JM
        • Jones PW
        Relationship between ventilation and breathlessness during exercise in chronic obstructive airways disease is not altered by prevention of hypoxaemia.
        Clin Sci. 1984; 67: 515-519
        • Vyas MN
        • Banister EW
        • Morton JW
        • et al.
        Response to exercise in patients with chronic airway obstruction.
        Am Rev Respir Dis. 1971; 103: 401-412
        • Maltais F
        • Simon M
        • Jobin J
        • et al.
        The effects of oxygen on lower limb blood flow and O2uptake during exercise in COPD.
        Med Sci Sports Exerc. 2001; 33: 916-922
        • Wadell K
        • Henriksson-Larsen K
        • Lundgren R
        Physical training with and without oxygen in patients with chronic obstructive pulmonary disease and exercise induced hypoxaemia.
        J Rehabil Med. 2001; 33: 200-205
        • Davidson AC
        • Leach R
        • George RJ
        • et al.
        Supplemental oxygen and exercise ability in chronic obstructive airways disease.
        Thorax. 1988; 43: 965-971
        • Somfay A
        • Porszasz J
        • Lee SM
        • et al.
        Dose-response effect of oxygen on hyperinflation and exercise endurance in nonhypoxaemic COPD patients.
        Eur Respir J. 2001; 18: 77-84
        • Lacasse Y
        • Lecours R
        • Pelletier C
        • et al.
        Randomised trial of ambulatory oxygen in oxygen-dependent COPD.
        Eur Respir J. 2005; 25: 1032-1038
        • Redelmeier DA
        • Bayoumi AM
        • Goldstein RS
        • et al.
        Interpreting small differences in functional status: the six minute walk test in chronic lung disease patients.
        Am J Respir Crit Care Med. 1997; 155: 1278-1282
        • Singh S
        • Jones PJ
        • Sewell L
        • et al.
        What is the minimum clinically important difference in the incremental shuttle walking test (ISWT) observed in pulmonary rehabilitation?.
        Eur Respir J. 2002; 20: 67S
        • Carpagnano GE
        • Kharitonov SA
        • Foschino-Bararo MP
        • et al.
        Supplementary oxygen in healthy subjects and those in COPD increases oxidative stress and airway inflammation.
        Thorax. 2004; 59: 1016-1019
        • Phillips M
        • Cataneo RN
        • Greenberg J
        • et al.
        Effect of oxygen on breath markers of oxidative stress.
        Eur Respir J. 2003; 21: 48-51