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Meta-Analysis
. 2013 Jul 25;2013(7):CD003884.
doi: 10.1002/14651858.CD003884.pub4.

Oxygen therapy for cystic fibrosis

Heather E Elphick  1 , George Mallory
Affiliations
Meta-Analysis

Oxygen therapy for cystic fibrosis

Heather E Elphick et al. Cochrane Database Syst Rev. .

Abstract

Background: The most serious complications of cystic fibrosis (CF) relate to respiratory insufficiency. Oxygen supplementation therapy has long been a standard of care for individuals with chronic lung diseases associated with hypoxemia. Physicians commonly prescribe oxygen therapy for people with CF when hypoxemia occurs. However, it is unclear if empiric evidence is available to provide indications for this therapy with its financial costs and often profound impact on lifestyle.

Objectives: To assess whether oxygen therapy improves the longevity or quality of life of individuals with CF.

Search methods: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register, comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Latest search of Group's Trials Register: 15 May 2013.

Selection criteria: Randomized or quasi-randomized controlled trials comparing oxygen, administered at any concentration, by any route, in people with documented CF for any time period.

Data collection and analysis: Authors independently assessed the risk of bias for included studies and extracted data.

Main results: This review includes 11 published studies (172 participants); only one examined long-term oxygen therapy (28 participants). There was no statistically significant improvement in survival, lung, or cardiac health. There was an improvement in regular attendance at school or work in those receiving oxygen therapy at 6 and 12 months. Four studies examined the effect of oxygen supplementation during sleep by polysomnography. Although oxygenation improved, mild hypercapnia was noted. Participants fell asleep quicker and spent a reduced percentage of total sleep time in rapid eye movement sleep, but there were no demonstrable improvements in qualitative sleep parameters. Six studies evaluated oxygen supplementation during exercise. Again, oxygenation improved, but mild hypercapnia resulted. Participants receiving oxygen therapy were able to exercise for a significantly longer duration during exercise. Other exercise parameters were not altered by the use of oxygen.

Authors' conclusions: There are no published data to guide the prescription of chronic oxygen supplementation to people with advanced lung disease due to CF. Short-term oxygen therapy during sleep and exercise improves oxygenation but is associated with modest and probably clinically inconsequential hypercapnia. There are improvements in exercise duration, time to fall asleep and regular attendance at school or work. There is a need for larger, well-designed clinical trials to assess the benefits of long-term oxygen therapy in people with CF administered continuously or during exercise or sleep or both. However, we do not expect any new research to be undertaken in this area any time soon and do not plan to update this review again until any new evidence does become available.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Oxygen therapy versus control, Outcome 1 Survival.
1.2
1.2. Analysis
Comparison 1 Oxygen therapy versus control, Outcome 2 Change in FEV1.
1.3
1.3. Analysis
Comparison 1 Oxygen therapy versus control, Outcome 3 Change in FVC.
1.4
1.4. Analysis
Comparison 1 Oxygen therapy versus control, Outcome 4 Change in gas exchange during exercise.
1.5
1.5. Analysis
Comparison 1 Oxygen therapy versus control, Outcome 5 Change in gas exchange during sleep.
1.6
1.6. Analysis
Comparison 1 Oxygen therapy versus control, Outcome 6 Change in PaO2.
1.7
1.7. Analysis
Comparison 1 Oxygen therapy versus control, Outcome 7 Change in PaCO2.
1.8
1.8. Analysis
Comparison 1 Oxygen therapy versus control, Outcome 8 Quality of life: regular attendance at school or work.
1.9
1.9. Analysis
Comparison 1 Oxygen therapy versus control, Outcome 9 Sleep parameters.
1.10
1.10. Analysis
Comparison 1 Oxygen therapy versus control, Outcome 10 Exercise parameters after submaximal exercise.
1.11
1.11. Analysis
Comparison 1 Oxygen therapy versus control, Outcome 11 Exercise parameters during maximal exercise.
1.12
1.12. Analysis
Comparison 1 Oxygen therapy versus control, Outcome 12 Nutritional status: change in % ideal body weight for height.
1.13
1.13. Analysis
Comparison 1 Oxygen therapy versus control, Outcome 13 Changes in right heart function.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Elkins 2004 {published data only}
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