Published ahead of print on April 13, 2006, doi:10.1164/rccm.200507-1161WS
American Journal of Respiratory and Critical Care Medicine Vol 174. pp. 373-378, (2006)
© 2006 American Thoracic Society
doi: 10.1164/rccm.200507-1161WS
Long-term Oxygen Treatment in Chronic Obstructive Pulmonary Disease: Recommendations for Future Research
An NHLBI Workshop Report
Thomas L. Croxton,
William C. Bailey for the NHLBI Working Group on Long-term Oxygen Treatment in COPD
Division of Lung Diseases, National Heart, Lung, and Blood Institute, Bethesda, Maryland; and Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
Correspondence and requests for reprints should be addressed to Tom Croxton, Ph.D., M.D., NHLBI, NIH, Room 10208, 6701 Rockledge Drive, Bethesda, MD 20892-7952. E-mail: croxtont{at}nhlbi.nih.gov
Long-term oxygen treatment (LTOT) prolongs life in patients with chronic obstructive pulmonary disease (COPD) and severe resting hypoxemia. Although this benefit is proven by clinical trials, scientific research has not provided definitive guidance regarding who should receive LTOT and how it should be delivered. Deficiencies in knowledge and in current research activity related to LTOT are especially striking in comparison to the importance of LTOT in the management of COPD and the associated costs. The National Heart, Lung, and Blood Institute, in collaboration with the Centers for Medicare and Medicaid Services, convened a working group to discuss research on LTOT. Participants in this meeting identified specific areas in which further investigation would likely lead to improvements in the care of patients with COPD or reductions in the cost of their care. The group recommended four clinical trials in subjects with COPD: (1) efficacy of ambulatory O2 supplementation in subjects who experience oxyhemoglobin desaturation during physical activity but are not severely hypoxemic at rest; (2) efficacy of LTOT in subjects with severe COPD and only moderate hypoxemia; (3) efficacy of nocturnal O2 supplementation in subjects who show episodic desaturation during sleep that is not attributable to obstructive sleep apnea; and (4) effectiveness of an activity-dependent prescription for O2 flow rate that is based on clinical tests performed at rest, during exercise, and during sleep.
Key Words: chronic bronchitis • hypoxia, therapy • lung diseases, obstructive • oxygen inhalation therapy • pulmonary emphysema
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