Oxygen for breathlessness in patients with chronic obstructive pulmonary disease who do not qualify for home oxygen therapy
Open accessAbstract
BACKGROUND: Breathlessness is a cardinal symptom of chronic obstructive pulmonary disease (COPD). Long-term oxygen therapy (LTOT) is given to improve survival time in people with COPD and severe chronic hypoxaemia at rest. The efficacy of oxygen therapy for breathlessness and health-related quality of life (HRQOL) in people with COPD and mild or no hypoxaemia who do not meet the criteria for LTOT has not been established. OBJECTIVES: To determine the efficacy of oxygen versus air in mildly hypoxaemic or non-hypoxaemic patients with COPD in terms of (1) breathlessness; (2) HRQOL; (3) patient preference whether to continue therapy; and (4) oxygen-related adverse events. SEARCH METHODS: We searched the Cochrane Airways Group Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase, to 12 July 2016, for randomised controlled trials (RCTs). We handsearched the reference lists of included articles. SELECTION CRITERIA: ) > 7.3 kPa) who were not already receiving LTOT. Two review authors independently assessed articles for inclusion in the review. DATA COLLECTION AND ANALYSIS: Two review authors independently collected and analysed data. We assessed risk of bias by using the Cochrane 'Risk of bias tool'. We pooled effects recorded on different scales as standardised mean differences (SMDs) with 95% confidence intervals (CIs) using random-effects models. Lower SMDs indicated decreased breathlessness and reduced HRQOL. We performed subanalyses and sensitivity analyses and assessed the quality of evidence according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. MAIN RESULTS: = 0%; low-quality evidence). Patient preference and adverse events could not be analysed owing to insufficient data. AUTHORS' CONCLUSIONS: We are moderately confident that oxygen can relieve breathlessness when given during exercise to mildly hypoxaemic and non-hypoxaemic people with chronic obstructive pulmonary disease who would not otherwise qualify for home oxygen therapy. Most evidence pertains to acute effects during exercise tests, and no evidence indicates that oxygen decreases breathlessness in the daily life setting. Findings show that oxygen does not affect health-related quality of life.
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Oxygen therapy does not improve breathlessness in patients with cancer, and its marginal benefit in COPD is of dubious clinical significance.
“Oxygen therapy, although it reverses hypoxaemia, does not improve breathlessness in patients with cancer, and the marginal benefit seen in a meta-analysis of COPD patients is of dubious clinical significance.”
From The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease (2017) · cites this paper as [17]
The Discussion (page not available in our copy) reports a modest reduction in COPD breathlessness during exercise and says its clinical importance is unclear; the Authors’ Conclusions likewise find no evidence of a clinically important benefit in daily life. The review does not establish the sentence’s separate claim that oxygen fails to improve breathlessness in patients with cancer. (LLM, conf=0.86)
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Breathlessness measurement should be standardised for the level of exertion
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Self-citationActualización 2021 de la Guía Española de la EPOC (GesEPOC). Tratamiento no farmacológico
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Self-citationBreathlessness measurement should be standardised for the level of exertion
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[Translated article] Spanish COPD Guidelines (GesEPOC 2021): Non-pharmacological Treatment Update
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Self-citationLong term oxygen therapy—it is still relevant?
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Oxygen Therapy for Isolated Exercise-Induced Hypoxemia Should Be Prescribed With Caution
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- Authors
- Ekström, M., Ahmadi, Z., Bornefalk-Hermansson, A., Abernethy, A., & Currow, D.
- Affiliations
- Lund University (SE)
- Uppsala University; Department of Statistics; Uppsala Sweden
- Duke Medical Center (US)
- Flinders University (AU)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2016-11-25
- Volume
- 2017
- Issue
- 8
- Pages
- CD006429-CD006429
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC6464154
- OpenAlex
- W2552100944
- Cited by
- 98
- References
- 121
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 11 · 2023: 7 · 2022: 10 · 2021: 14 · 2020: 10 · 2019: 15 · 2018: 17 · 2017: 8
- FWCI
- 2.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Repository@Hull (Worktribe) (University of Hull) (submittedVersion, cc-by)
- Lund University Publications (Lund University) (submittedVersion)
- UTS ePRESS (University of Technology Sydney) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Keywords
- chronic obstructive pulmonary disease, long-term oxygen therapy, supplemental oxygen, dyspnea, health-related quality of life, physical activity, patient preferences, adverse events
- MeSH terms
- Dyspnea, Health Status, Home Care Services, Humans, Oxygen Inhalation Therapy, Quality of Life, Exercise, Randomized Controlled Trials as Topic, Pulmonary Disease, Chronic Obstructive
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