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First published online on July 18, 2008
Chest, doi:10.1378/chest.08-0117
A more recent version of this article appeared on September 1, 2008
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Continuous Oxygen Use in Non-Hypoxemic Emphysema Patients Identifies a High-Risk Subset of Patients: Retrospective Analysis of the National Emphysema Treatment Trial

Michael B Drummond1; Amanda L Blackford2; Joshua O Benditt3; Barry J Make4; Frank C Sciurba5; Meredith C McCormack1; Fernando J Martinez6; Henry E Fessler1; Alfred P Fishman7 and Robert A Wise1

1Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 2Division of Biostatistics, Department of Oncology, Johns Hopkins University, Baltimore, MD 3University of Washington, Seattle, WA 4National Jewish Medical Center, Denver, CO 5University of Pittsburgh, Pittsburgh, PA 6University of Michigan, Ann Arbor, MI 7University of Pennsylvania, Philadelphia, PA

mdrummo3{at}jhmi.edu

Abstract

BACKGROUNDContinuous oxygen therapy is not recommended for emphysema patients who are non-hypoxemic at rest, although it is often prescribed1. Little is known regarding the clinical characteristics and survival of non-hypoxemic emphysema patients using continuous oxygen. Analysis of data from the National Emphysema Treatment Trial (NETT) offers insight into this population.

METHODSWe analyzed demographic and clinical characteristics of 1215 participants of NETT, stratifying by resting PaO2 and reported oxygen use. Eight year survival was evaluated in individuals randomized to medical therapy.

RESULTSAt enrollment, 33.8% (n=260) of participants non-hypoxemic at rest reported continuous oxygen use. When compared to non-hypoxemic individuals not using oxygen (n=226), those using continuous oxygen had worse dyspnea, lower quality of life, more frequent exercise desaturation and higher case fatality rate. After adjusting for age, BMI, and FEV1 % predicted, the presence of exercise desaturation accounted for the differential mortality seen between these groups.

CONCLUSIONSIn NETT, the use of continuous oxygen in resting non-hypoxemic emphysema patients was associated with worse disease severity and survival. The differential survival observed could nearly all be accounted for by the higher prevalence of exercise desaturation in those using continuous oxygen, suggesting that it is not a harmful effect of oxygen therapy contributing to mortality. It remains unclear whether continuous oxygen therapy improves survival in normoxic patients with exercise desaturation.

Key Words: pulmonary disease • chronic obstructive • supplemental oxygen • guideline adherence






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