Short-term oxygen therapy need in COPD patients indicative of worse outcomes in acute illness: Study
Canada: Persistent hypoxemia requiring short-term oxygen therapy (STOT) following an acute respiratory illness in COPD is a marker of disease progression to long-term oxygen therapy (LTOT), states a recent study.
The study, published in the International Journal of Chronic Obstructive Pulmonary Disease, stresses the recommendation for close monitoring of patients discharged from hospitals with STOT. Requirement for STOT at discharge in the course of an acute respiratory illness in COPD leads to poor prognosis.
The researchers wrote, "in patients who received STOT, we also identified predictors of progression to LTOT." They suggest continuing LTOT in patients with severe hypoxemia after a period of one month of home oxygen therapy and/or in those having more than one STOT episode.
Short-term oxygen therapy is often given to allow patients with chronic obstructive pulmonary disease (COPD) to be discharged safely from the hospital following an acute illness. However, this practice is not based on evidence and is still being widely accepted. Considering this, Yves Lacasse, Quebec Heart and Lung Institute - Laval University, Québec, Canada, and colleagues aimed to describe the characteristics and outcomes of COPD patients who received STOT.
The researchers performed a secondary analysis of the INOX trial, a 4-year randomized trial of nocturnal oxygen in COPD. The trial showed that nocturnal oxygen has no significant effect on survival or progression to LTOT. This allowed researchers to merge patients who o received nocturnal oxygen and those who received placebo into a single cohort to study the predictors and outcomes of STOT regardless of the treatment received during the trial.
The key findings of the study are as follows:
- Among the 243 participants in the trial, 60 required STOT on at least one occasion during follow-up.
- Patients requiring STOT had more severe dyspnoea and lung function impairment, and lower PaO2 at baseline than those who did not. STOT was associated with subsequent LTOT requirements (hazard ratio [HR]: 4.59) and mortality (HR: 1.93).
- The association between STOT and mortality was confounded by age, disease severity, and comorbidities.
- Periods of STOT of more than one month and/or repeated prescriptions of STOT increased the probability of progression to LTOT (OR: 5.07).
"Persistent hypoxemia following 1 month of STOT or more than 1 episode of STOT increases the probability of progression to long-term oxygen therapy by 5 folds," the researchers conclude.
In simpler words, COPD patients who required STOT in the course of an acute respiratory illness had more severe disease than those who did not and progressed more frequently towards LTOT during follow-up.
Reference:
Soumagne T, Maltais F, Corbeil F, Paradis B, Baltzan M, Simão P, Abad Fernández A, Lecours R, Bernard S, Lacasse Y. Short-Term Oxygen Therapy Outcomes in COPD. Int J Chron Obstruct Pulmon Dis. 2022;17:1685-1693
https://doi.org/10.2147/COPD.S366795
