Domiciliary oxygen for chronic obstructive pulmonary disease

Abstract

Background: Domiciliary oxygen therapy has become one of the major forms of treatment for hypoxaemic chronic obstructive pulmonary disease (COPD) patients.

Objectives: To determine the effect of domiciliary oxygen therapy on survival and quality of life in patients with COPD.

Search strategy: Randomised controlled trials (RCTs) were identified using the Cochrane Airways Group COPD register using the search terms: home OR domiciliary AND oxygen.

Selection criteria: Any RCT in patients with hypoxaemia and COPD that compared long term domiciliary or home oxygen therapy with a control treatment.

Data collection and analysis: Data extraction was performed independently by two reviewers.

Main results: Five randomised controlled trials were identified. Data was aggregated from two trials of the treatment of nocturnal oxygen therapy in patients with mild to moderate COPD and arterial desaturation at night. Data could not be aggregated for the other three trials because of differences in trial design and patient selection. Nott 1980: continuous oxygen therapy versus nocturnal oxygen therapy: there was a significant improvement in mortality after 24 months (Peto odds ratio 0.45, 95% confidence interval 0.25 to 0.81). MRC 1981: domiciliary oxygen therapy versus no oxygen therapy: there was a significant improvement over five years in mortality in the group receiving oxygen therapy (Peto odds ratio 0.42, 95% confidence interval 0.18 to 0.98). In two studies of nocturnal oxygen versus no oxygen in patients with COPD and arterial desaturation at night: there was no difference in mortality between treated and non treated groups for either trial or when the trials were aggregated. In one study of long term oxygen versus no oxygen in moderate hypoxaemia: there was no effect on survival for up to three years of follow up.

Reviewer's conclusions: Long term oxygen therapy improved survival in a selected group of COPD patients with severe hypoxaemia (arterial PO2 less than 8.0 kPa). Long term oxygen did not appear to improve survival in patients with moderate hypoxaemia or in those with only arterial desaturation at night.