Published ahead of print on April 19, 2007, doi:10.1164/rccm.200702-308OC Am. J. Respir. Crit. Care Med., Volume 176, Number 4, August 2007, 343-349 A more recent version of this article appeared on August 15, 2007
Submitted on February 23, 2007 Effect of Oxygen on Health Quality of Life in COPD Patients with Transient Exertional HypoxemiaMika L Nonoyama1,1 Graduate Department of Rehabilitation Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada, 2 Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada, 3 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada, 4 Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada * To whom correspondence should be addressed. E-mail: rgoldstein{at}westpark.org.
Rationale: Ambulatory oxygen improves acute exercise performance in people with Chronic Obstructive Pulmonary Disease (COPD). This improvement may not translate into symptomatic benefit for patients, during activities of daily living.
Objectives: We undertook a series of individual randomized controlled trials (N-of-1 RCTs) to measure the effect of oxygen in patients with COPD who do not meet criteria for mortality reduction with long-term oxygen therapy (LTOT).
Methods: Twenty-seven patients completed blinded N-of-1 RCTs, each comprising 3 pairs of 2-week home treatment periods, with oxygen provided during one period of each pair and a placebo mixture during the other.
Measurements: Patients completed the Chronic Respiratory Questionnaire (CRQ), the St. George's Respiratory Questionnaire (SGRQ), and a home 5 minute walk test (5MWT) at the end of each period. We defined a positive response as a CRQ dyspnea score greater (less dyspnea) on oxygen than placebo during all 3 pairs, with a difference Key words: chronic obstructive pulmonary disease, oxygen, placebo, exertion
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0.5 in at least 2 pairs.
Results: Oxygen significantly increased the 5MWT (427 versus 412 steps, p=0.04). Two of 27 patients met the responder criteria. Among the whole group, neither the CRQ nor the SGRQ showed any statistical or clinical differences between oxygen and placebo.
Conclusions: This study does not support the general application of long-term ambulatory oxygen therapy for patients with COPD who do not meet criteria for mortality reduction with LTOT. N-of-1 RCTs can identify patients who may benefit.
