Psychologic effects of continuous and nocturnal oxygen therapy in hypoxemic chronic obstructive pulmonary disease

The Nocturnal Oxygen Therapy Trial (NOTT) showed previously that patients with hypoxemic chronic obstructive pulmonary disease (COPD) frequently suffered from neuropsychologic deficit and experienced disturbed mood, personality, and life quality. The present study has followed up 150 NOTT patients six months after they were randomized to continuous oxygen treatment (COT) or nocturnal oxygen treatment (NOT). Tested off oxygen, 42% showed modest neuropsychologic improvement after six months of therapy, and the rates for COT and NOT were comparable. A subsample (n = 37) was examined a third time, after 12 months of treatment. At this point patients receiving COT registered better neuropsychologic performance than those receiving NOT. Concurrently, the COT group began showing improved survival. Despite mild neuropsychologic improvement, patients reported little change in emotional status or life quality. It is concluded that prolonged oxygen treatment is associated with small but definite improvement in brain functioning among patients with hypoxemic COPD, and that COT might have some advantage over NOT in enhancing neuropsychologic functioning as well as survival.     

Home oxygen therapy in chronic obstructive pulmonary disease

Home oxygen therapy has been shown to prolong life in patients with hypoxemic chronic obstructive lung disease. Patients who are hypoxemic when stable (Po2 less than 55 torr or Po2 55 to 59 torr with evidence of cor pulmonale or polycythemia) should be so treated, with oxygen supplied as continuously as possible.     

A review of long-term oxygen therapy for chronic obstructive pulmonary disease.

This study aimed to review the evidence for the use of long-term oxygen therapy for patients with chronic obstructive pulmonary disease (COPD). The design was a systematic Cochrane review of randomized controlled trials (RCTs) of long-term oxygen therapy for COPD and main outcome measure was survival on home oxygen therapy. Five RCTs were identified. Data from two trials of nocturnal oxygen therapy in mild to moderate hypoxaemia were aggregated. Data from the other three trials could not be aggregated because of differences in trial design and patient selection. Treatment with continuous versus nocturnal oxygen therapy produced a significant improvement in mortality after 24 months [Peto odds ratio 0.45, 95% confidence interval (95% CI) 0.25-0.81] for the continuous therapy group. Treatment with oxygen therapy versus no oxygen therapy showed a significant improvement in mortality after five years in the group receiving oxygen therapy (Peto odds ratio 0.42, 95% CI 0.18-0.98). There was no difference in mortality for patients with COPD and mild to moderate daytime hypoxaemia and nocturnal desaturation receiving nocturnal oxygen therapy versus no oxygen therapy or sham treatment. Long-term oxygen therapy versus no oxygen therapy in patients with COPD and moderate hypoxaemia had no effect on survival. In conclusion, long-term oxygen therapy improved survival in a selected group of COPD patients with severe hypoxaemia but few co-morbidities. Long-term oxygen therapy did not improve survival in patients with moderate hypoxaemia or in those with mild to moderate hypoxaemia and arterial desaturation at night.     

长期家庭氧疗对缓解期COPD患者的影响研究

目的观察长期家庭氧疗对缓解期COPD患者的肺功能及血气影响。方法选择60例缓解期COPD患者随机分为两组,笫1组单纯家庭氧疗（每天15小时以上）,笫2组不给予氧疗,1年后观察两组FEV1%预计值、血气的变化情况。结果氧疗组FEV1%预计值、动脉血氧分压明显高于对照组（P〈0.01）。结论长期家庭氧疗可以改善COPD患者的动脉血氧分压和肺功能。     

Relationship of ventricular ectopy to nocturnal oxygen desaturation in patients with chronic obstructive pulmonary disease

Sudden death and oxyhemoglobin desaturation are known to occur during sleep in patients with chronic obstructive pulmonary disease. The present study was undertaken to determine the frequency with which nocturnal oxygen desaturation promotes an increase in ventricular ectopic activity, since such a relationship could represent a potential pathophysiologic mechanism for sudden death during sleep. Forty-two clinically stable subjects with moderately severe obstructive airways disease, mean ratio of one-second forced expiratory volume to forced vital capacity = 51 +/- 12 percent, underwent overnight polygraphic sleep study. Oxyhemoglobin saturation was monitored by ear oximetry, and electrocardiographic leads CC5 and CM5 were employed for arrhythmia detection. Premature ventricular complexes were detected in 27 (64 percent) of the subjects and were complex (multifocal, repetitive, or both) in 17. No significant relationship between premature ventricular complex frequency and arterial oxygen saturation was detected for the group as a whole. In part, this result can be attributed to the relatively mild hypoxemic stress experienced by the 22 subjects in whom arterial oxygen saturation remained greater than 80 percent. In contrast, six (30 percent) of the 20 patients who had desaturation to less than 80 percent showed a greater than 150 percent increase in premature ventricular complex frequency with oxygen desaturation. These results suggest that nocturnal hypoxemia, if of sufficient magnitude, is capable of increasing ventricular ectopy during sleep in a substantial number of patients with chronic obstructive pulmonary disease.     

Effects of long-term oxygen therapy in patients with chronic obstructive pulmonary disease

Long-term oxygen therapy is largely used in the management of severe hypoxemia in patients with chronic obstructive pulmonary disease. It was demonstrated that long-term oxygen therapy prolongs life, prevents progression of hypoxic pulmonary hypertension, and controls polycythemia. Recent data suggest that in patients with moderate hypoxemia (Pao2 > 55 mm Hg), long-term oxygen therapy does not prolong life. Life expectancy in those patients seems to depend on the severity of airway obstruction. Long-term oxygen therapy improves cognitive functions and emotional status. There is some evidence suggesting that it also improves quality of life, but more data are needed. There are conflicting data concerning the rationale for nocturnal oxygen supplementation in patients with arterial blood desaturation during sleep.     

Prognosis for chronic obstructive pulmonary disease patients who receive long-term oxygen therapy.

OBJECTIVE: To investigate the survival of patients with chronic obstructive pulmonary disease (COPD) receiving long-term oxygen therapy (LTOT). DESIGN: Retrospective study of 124 patients (76 males and 48 females, mean age 68 years) using LTOT from 1990 to 1996, studied with lifetable analyses. Seventy-six patients with PaO2 < or = 7.3 kPa, and 48 patients with PaO2 > or = 7.4 kPa were allocated to Groups I and II, respectively. RESULTS: The groups had similar FEV1 and FVC levels. The 2- and 5-year survival rates were 73% and 50%, respectively, in Group I, and 78% and 40% in Group II. PaCO2 and FVC were predictors of survival in Group II. Women lived significantly longer than men (Group I: P < 0.01, relative risk [RR] 0.341) but had better FEV1 (P < 0.01). Survival was significantly poorer for patients in the general hospital (P < 0.05, RR 2.096) compared with those at a university hospital. CONCLUSION: Survival during LTOT was similar in patients with and without severe hypoxaemia at the same level of loss of lung function. Survival was poorer when LTOT was not prescribed and followed in a department of respiratory medicine.     

慢性阻塞性肺疾病昼夜血氧变化及其临床意义

已有研究表明慢性阻塞性肺疾病(COPD)患者血氧的波动在氧化应激、炎症反应中均起重要作用[1]。由于COPD患者白天可能已有低氧血症,因此单纯夜间血氧饱和度水平不能真正反映昼夜血氧变化情况,而目前关于血氧的昼夜变化幅度对病情影响的研究较少。因此,本研究将从COPD患者昼夜血氧变化幅度的角度探讨其临床意义。     

长期氧疗对慢性阻塞性肺疾病患者的影响

本文首先介绍了慢性阻塞性肺疾病患者施行长期氧疗主要生理性改变,分析比较了国外关于长期氧疗对慢性阻塞性肺疾病患者病死率、肺功能、睡眠和运动等方面的影响,介绍了目前主要的氧疗指征,并进一步探讨了慢性阻塞性肺疾病患者施行长期氧疗可能的获益及如何预测长期氧疗的效果,从而提高对长期氧疗的全面认识.

Abstract：

This artical describes the major physiological changes of long-term oxygen therapy in chronic obstructive pulmonary disease (COPD) patients. Analysis long-term oxygen therapy on mortality in COPD patients, pulmonary function, sleep, exercise and other aspect in foreign countries, introduce the current main indications for oxygen therapy, and discussed futher in benefit of long-term oxygen therapy in patients with COPD, and how to predict the effects of long-term oxygen therapy, thereby improving the overall knowledge of the long-term oxygen therapy.     

Psychosocial effects of continuous oxygen therapy in hypoxaemic chronic obstructive pulmonary disease patients

Twenty six hypoxaemic patients with severe and stable chronic obstructive pulmonary disease (COPD) were treated with continuous domiciliary oxygen for a six month period. The patients were evaluated 1, 3 and 6 months after the start of oxygen therapy. In addition to blood gas analysis, 15 coping skills were evaluated by the patient and by the nurse, who also rated the general activity of the patients. Depression was measured by Beck Depression Inventory (BDI) at the start of the trial and after six months' oxygen therapy. The general psychosocial response was meagre; no significant changes were observed in any psychosocial measures. The response was slightly better in younger and less hypoxaemic patients. We conclude that the psychosocial response to oxygen therapy in severely hypoxaemic COPD patients is limited.     

慢性阻塞性肺疾病患者夜间低氧发生情况的初步探讨

目的探讨慢性阻塞性肺疾病（COPD）患者夜间低氧的发生情况并探讨其发病机制。方法将60例COPD稳定期患者分为两组：非呼吸衰竭组（40例）、呼吸衰竭组（20例）,另选急性肺炎治愈患者作为对照组（20例）。采用东方万泰公司提供的便携式初筛诊断仪进行睡眠监测。结果夜间低氧血症在三组的发生率分别为45％、100％及10％,COPD组明显高于对照组（P〈0．05）。夜间低氧与日间血氧饱和度（SaO2）相关。结论COPD患者夜间睡眠时出现低氧或低氧血症加重,夜间低氧血症可通过白天SaO2来预测,COPD与睡眠暂停低通气综合征（OSAHS）并存可加重夜间低氧血症。     

Hemodynamic response to oxygen therapy in chronic obstructive pulmonary disease

At six centers, 203 patients with stabilized hypoxemic chronic obstructive pulmonary disease were evaluated hemodynamically during a continuous or 12-hour oxygen therapy program. Neither oxygen therapy program resulted in correction or near-correction of the baseline hemodynamic abnormalities. The continuous oxygen therapy group did show improvement in pulmonary vascular resistance, pulmonary arterial pressure, and stroke volume index. The improvement in pulmonary vascular resistance was associated with improved cardiac function, as evidenced by an increase in baseline and exercise stroke volume index. The nocturnal oxygen therapy group showed stable hemodynamic variables. For both groups, changes in mean pulmonary artery pressure during the first 6 months were associated with subsequent survival after adjustment for association with the baseline mean pulmonary artery pressure. Continuous oxygen therapy can improve the hemodynamic abnormalities of patients with hypoxic chronic obstructive pulmonary disease. The hemodynamic response to this treatment is predictive of survival.     

Managing chronic obstructive pulmonary disease in the community. A randomized controlled trial of home-based pulmonary rehabilitation for elderly housebound patients

PURPOSE: Pulmonary rehabilitation is essential for managing chronic obstructive pulmonary disease (COPD). Housebound COPD patients are frequently excluded from this treatment because they are unable to access outpatient pulmonary rehabilitation programs because of the severity of their disease. This randomized controlled trial assesses the effects of a 12-week home-based pulmonary rehabilitation program for 60 housebound COPD patients older than 60 years. METHODS: Intervention patients received an individually tailored supervised walking and arm exercise program as well as individual multidisciplinary education sessions on COPD and its management. Outcomes were assessed using the 6-minute walk test, St George's respiratory questionnaire, and Borg score of perceived breathlessness. Healthcare utilization was assessed using hospital admission rates with exacerbation of COPD and average length of stay at readmission. RESULTS: Complete data for 23 patients in each group were available for analysis. There was no significant difference between groups on baseline measures. Compared with the control group, intervention patients demonstrated a significant improvement in 6-minute walk test (P = .023), Borg score of perceived breathlessness (P = .024), St George's respiratory questionnaire total score (P = .020), and impact subscore (P = .024). At 6 months, the intervention group had a significantly shorter average length of stay at readmission to hospital with exacerbation (P = .035). CONCLUSION: A 12-week home-based pulmonary rehabilitation is effective in improving exercise tolerance, perception of breathlessness, and quality of life for housebound COPD patients. To manage COPD in the community more effectively, health services should focus on expanding home-based pulmonary rehabilitation.     

A randomized,controlled trial comparing long-term and short-term exercise in patients with chronic obstructive pulmonary disease

PURPOSE: To compare the effects of short-term (3 months) and long-term (18 months) involvement in an exercise program on self-reported disability and physical function in patients with chronic obstructive pulmonary disease (COPD). METHODS: A total of 140 patients with COPD were studied in a randomized, single-blinded clinical trial. Self-reported disability and physical function were assessed using a 21-item questionnaire, a 6-minute walk, timed stair climb, and an overhead task. RESULTS: At the completion of the trial, participants in the long-term intervention reported 12% less disability than those in the short-term intervention (adjusted mean with 95% confidence interval, 1.53 (1.43-1.63) versus 1.71 (1.61 to 1.81) units, respectively; P=.016), walked 6% farther during 6-minutes (1,815.0 [1,750.4-1,879.6] vs 1,711.5 [1,640.7-1,782.3] feet, respectively), climbed steps 11% faster (11.6 [11.0-12.2] vs 12.9 [12.3-13.5] seconds, respectively), and completed an overhead task 8% faster (46.8 [44.4-49.2] vs 50.4 [47.8-53.0] seconds, respectively) than those in the short-term intervention. CONCLUSION: An 18 month exercise program results in greater improvements in self-reported disability and physical function in patients with COPD when compared with a 3-month exercise program. As such, long-term exercise should be recommended for all patients with COPD.