COPD and Moderate Hypoxemia: Is Home Oxygen Beneficial?

Home oxygen probably makes no difference to the 3-year death rate among patients with chronic obstructive pulmonary disease (COPD) and moderate hypoxemia, according to a systematic review and meta-analysis published in The Lancet Respiratory Medicine.

The best approach to management of moderate hypoxemia in patients with COPD who fail to qualify for long-term oxygen therapy (LTOT) is unclear. Researchers aimed to evaluate the usefulness of home oxygen — either nocturnal oxygen therapy or LTOT — on patient survival in COPD and moderate hypoxemia. The primary endpoint was 3-year mortality.

The researchers conducted a systematic review and meta-analysis of studies of patients with COPD and moderate daytime hypoxemia or isolated nocturnal desaturation who had participated in parallel-group randomized trials of long-term or nocturnal oxygen. The review included the Cochrane Central Register of Controlled Trials, CINHAL, Embase, Web of Science, and MEDLINE databases from inception thru mid-January, 2022. The investigators found 6 randomized trials with high-quality evidence published between 1992 and 2020; however, 1 of these trials was ultimately excluded from the final analysis due to an unclear number of deaths at 3-year follow-up.

Primary meta-analysis of the 5 trials, which included 1002 patients, revealed a near absence of effect of home oxygen in reducing 3-year mortality (relative risk 0.91; 95% CI, 0.72-1.16; τ²=0.00). Researchers also reported all 6 studies were negative for the outcome of mortality.

Limitations of this research include the use of aggregate data only, the small number of trials included in analysis, and the lack of accounting for negative effects of low-flow home oxygen.

Researchers said their results indicate that “home oxygen probably makes little or no difference to 3-year mortality in patients with COPD and moderate hypoxemia” and “probably has little or no beneficial effect on important outcomes such as rates of exacerbation and hospitalization or quality of life in patients with COPD and uncomplicated moderate hypoxemia.” They further noted that their results do not support the current widespread use of home oxygen in patients with COPD and mild hypoxemia.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Lacasse Y, Casaburi R, Sliwinski P, et al. Home oxygen for moderate hypoxaemia in chronic obstructive pulmonary disease: A systematic review and meta-analysis. Lancet Respir Med. Published online July 8, 2022. doi:10.1016/S2213-2600(22)00179-5