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Long-Term Oxygen for COPD with Moderate Desaturation

N Engl J Med; 2016 Oct 27; Albert, Au, et al

Publish date:

The prescription of long-term supplemental oxygen did not result in a longer time to death or first hospitalization than no long-term supplemental oxygen in patients with stable chronic obstructive pulmonary disease (COPD) and resting or exercise-induced moderate desaturation, a recent study found. A total of 738 patients at 42 centers were randomly assigned in a 1:1 ratio to receive long-term supplemental oxygen (supplemental-oxygen group) or no long-term supplemental oxygen (no-supplemental-oxygen group) and followed for 1 to 6 years. The group studied was patients with stable COPD and resting pulse oximetry of 89% to 93%, or patients who had moderate exercise-induced desaturation during the 6-minute walk test, with pulse oximetry ≥80% for ≥5 minutes and <90% for ≥10 seconds.

Researchers found:

• No significant difference between the supplemental-oxygen group and the no-supplemental-oxygen group was found in the time to death or first hospitalization (HR, 0.94).

• No significant difference between the supplemental-oxygen group and the no-supplemental-oxygen group was found in the rates of all hospitalizations (RR, 1.01), COPD exacerbations (RR, 1.08), and COPD-related hospitalization (RR, 0.99).

• No consistent between-group differences were found in measures of quality of life, lung function, and distance walked in 6 minutes.

Citation: Albert RK, Au DH, Blackford AL, et al. A randomized trial of long-term oxygen for COPD with moderate desaturation. N Engl J Med. 2016;375:1617-1627. doi:10.1056/NEJMoa1604344.

Commentary: Current Medicare guidelines cover oxygen for patients with pulse oximetry at rest <88%, based on firm evidence of significant mortality benefit shown over 30 years ago. For patients who have a pulse ox of >89% at rest, supplemental oxygen is covered if their exercise pulse ox falls to <88% and pulse ox improves with oxygen, or if it falls to <88% for at least 5 minutes during sleep. Patients also meet criteria if their pulse ox is 89% and they have dependent peripheral edema, pulmonary hypertension, or hematocrit >56%.1,2 This study clarifies an important area that many patients and physicians have questioned and shows that supplemental oxygen simply does not benefit patients with moderate degrees of hypoxia who have resting pulse oximetry between 89% to 93%. —Neil Skolnik, MD

1. Department of Health and Human Services (Medicare Learning Network). Home oxygen therapy. August 2015. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Home-Oxygen-Therapy-Text-Only.pdf. Accessed November 4, 2016.

2. Nocturnal Oxygen Therapy Trial Group. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Ann Intern Med. 1980;93:391-8.

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