DÄ internationalArchive16/2019Oxygen Therapy for Isolated Exercise-Induced Hypoxemia Should Be Prescribed With Caution
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In confirmed resting hypoxemia (oxygen partial pressure [pO2] ≤ 55 mm Hg) over a period of 4 weeks, long-term oxygen therapy (LTOT) can improve patients’ prognosis. Twenty-four percent of our blood gas analyses with LTOT indication had a pO2 of exactly 55 mm Hg.

In patients with moderate exercise-induced hypoxemia (pulse oximetry saturation [SpO2] 80–88%) and resting pO2 >55 mmHg, oxygen therapy, however, should be viewed critically. In our opinion, prescription of oxygen (O2) therapy is too liberal in Germany in this setting, and is frequently not reviewed properly. Exercise-induced hypoxemia (median minimal exercise SpO2 of 84%) with resting pO2 >55 mm Hg was found in 29% of the 575 patients with chronic obstructive pulmonary disease (COPD) referred to our center in the period from 2015 to 2018 for lung transplantation (median forced expiratory volume in 1 second of 22%). Sixty-three percent of this subgroup had a current O2 prescription (compare LOTT study: 33%).

The effects of oxygen administration in patients with isolated exercise-induced hypoxemia are below the minimal clinically important difference. Air flow alone can alleviate shortness of breath. In a meta-analysis, oxygen administration on exertion improved the 6-minute walking distance (6MWD) in COPD patients only by 18.8 m compared to placebo (compressed air) (1). In a meta-analysis of 16 studies on COPD patients with exercise-induced hypoxemia, dyspnea was reduced by oxygen administration only by 0.7 points on a scale from 0 to 10, compared to placebo (2). Moreover, in 84 patients with pulmonary fibrosis and isolated exercise-induced hypoxemia, quality of life improved with oxygen therapy by just 4% in a 4-week crossover study (oxygen administration versus no oxygen administration) and 6MWD only by 18.5 m, compared to compressed air (3). Oxygen therapy has no effect on survival in patients with isolated exercise-induced hypoxemia.

Oxygen therapy is costly and associated with side effects. In patients with isolated exercise-induced hypoxemia, home oxygen therapy should only be prescribed if a mobile patient describes severe exercise-induced dyspnea, oxygen compared to compressed air has a clinically important effect and the patient is willing to use oxygen therapy.

DOI: 10.3238/arztebl.2019.0287a

Prof. Dr. med. Jens Gottlieb

Deutsches Zentrum für Lungenforschung (DZL)

Medizinische Hochschule Hannover

Klinik für Pneumologie OE 6870

Hannover

Germany

Gottlieb.Jens@mh-hannover.de

Dr. med. Martin Dierich

Abteilung für Pneumologie

Klinik Bad Fallingbostel

Bad Fallingbostel

Germany

PD. Dr. med. Thomas Fühner

Klinik für Pneumologie und Beatmungsmedizin

Städtisches Klinikum Braunschweig

Braunschweig

Germany

PD. Dr. med. Heiko Golpon

Deutsches Zentrum für Lungenforschung (DZL)

Medizinische Hochschule Hannover

Klinik für Pneumologie OE 6870

Hannover

Germany

1.
Bradley JM, O‘Neill B: Short-term ambulatory oxygen for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2005; 4: CD00435 CrossRef CrossRef
2.
Ekström M, Ahmadi Z, Bornefalk-Hermansson A, Abernethy A, Currow D: Oxygen for breathlessness in patients with chronic obstructive pulmonary disease who do not qualify for home oxygen therapy. Cochrane Database Syst Rev 2016; 11: CD006429 CrossRef
3.
Visca D, Mori L, Tsipouri V, et al.: Effect of ambulatory oxygen on quality of life for patients with fibrotic lung disease (AmbOx): a prospective, open-label, mixed-method, crossover randomised controlled trial. Lancet Respir Med 2018; 6: 759–70 CrossRef
4.
Koczulla AR, Schneeberger T, Jarosch I, Kenn K, Gloeckl R: Long-term oxygen therapy—current evidence and practical, day to day considerations. Dtsch Arztebl Int 2018; 115: 871–7 VOLLTEXT
1.Bradley JM, O‘Neill B: Short-term ambulatory oxygen for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2005; 4: CD00435 CrossRef CrossRef
2.Ekström M, Ahmadi Z, Bornefalk-Hermansson A, Abernethy A, Currow D: Oxygen for breathlessness in patients with chronic obstructive pulmonary disease who do not qualify for home oxygen therapy. Cochrane Database Syst Rev 2016; 11: CD006429 CrossRef
3.Visca D, Mori L, Tsipouri V, et al.: Effect of ambulatory oxygen on quality of life for patients with fibrotic lung disease (AmbOx): a prospective, open-label, mixed-method, crossover randomised controlled trial. Lancet Respir Med 2018; 6: 759–70 CrossRef
4.Koczulla AR, Schneeberger T, Jarosch I, Kenn K, Gloeckl R: Long-term oxygen therapy—current evidence and practical, day to day considerations. Dtsch Arztebl Int 2018; 115: 871–7 VOLLTEXT

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