Short-Term Oxygen Therapy Outcomes in COPD

Thibaud Soumagne,1 François Maltais,1 François Corbeil,2 Bruno Paradis,3 Marc Baltzan,4 Paula Simão,5 Araceli Abad Fernández,6 Richard Lecours,7 Sarah Bernard,1 Yves Lacasse1 for the INOX Trial Group1Quebec Heart and Lung Institute, Laval University, Quebec, Canada; 2Trois-Rivières Affiliated Hospital, Trois-Rivières, Canada; 3Laval Integrated Center of Health and Social Services, Laval, Canada; 4Mount Sinai Hospital, McGill University, Montreal, Canada; 5Pedro Hispano Hospital, Matosinhos, Portugal; 6Getafe University Hospital, Getafe, Spain; 7Hôtel-Dieu de Lévis Affiliated Hospital, Lévis, CanadaCorrespondence: Yves Lacasse, Quebec Heart and Lung Institute - Laval University, 2725 Ste-Foy Road, Québec, P, Québec, G1V 4G5, Canada, Tel +1 418-656-4747, Fax +1 418-656-4762, Email Yves.Lacasse@med.ulaval.caRationale: Short-term oxygen therapy (STOT) is often prescribed to allow patients with chronic obstructive pulmonary disease (COPD) to be discharged safely from hospital following an acute illness. This practice is widely accepted without being based on evidence.Purpose: Our objective was to describe the characteristics and outcomes of patients with COPD who received STOT.Patients and Methods: The study was a secondary analysis of the INOX trial, a 4-year randomised trial of nocturnal oxygen in COPD. The trial indicated that nocturnal oxygen has no significant effect on survival or progression to LTOT, allowing our merging of patients who 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.Results: 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 requirement (hazard ratio [HR]: 4.59; 95% confidence interval [CI]: 2.98– 7.07) and mortality (HR: 1.93; 95% CI: 1.15– 3.24). 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; 95% CI: 1.48– 18.8).Conclusion: Following an acute respiratory illness in COPD, persistent hypoxaemia requiring STOT is a marker of disease progression towards the requirement for LTOT.Keywords: oxygen therapy, short-term, long-term, mortality, chronic obstructive pulmonary diseas