Michael B Drummond1, Amanda L Blackford2, Joshua O Benditt3, Barry J Make4, Frank C Sciurba5, Meredith C McCormack6, Fernando J Martinez7, Henry E Fessler8, Alfred P Fishman7, Robert A Wise6. 1. Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: mdrummo3@jhmi.edu. 2. Division of Biostatistics, Department of Oncology, Johns Hopkins University, Baltimore, MD. 3. University of Washington, Seattle, WA. 4. National Jewish Medical Center, Denver, CO. 5. University of Pittsburgh, Pittsburgh, PA. 6. Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD. 7. University of Michigan, Ann Arbor, MI. 8. University of Pennsylvania, Philadelphia, PA.
Abstract
BACKGROUND:Continuous oxygen therapy is not recommended for emphysema patients who are not hypoxemic at rest, although it is often prescribed. Little is known regarding the clinical characteristics and survival of nonhypoxemic emphysema patients using continuous oxygen. Analysis of data from the National Emphysema Treatment Trial (NETT) offers insight into this population. METHODS: We analyzed demographic and clinical characteristics of 1,215 participants of NETT, stratifying by resting PaO(2) and reported oxygen use. Eight-year survival was evaluated in individuals randomized to medical therapy. RESULTS: At enrollment, 33.8% (n = 260) of participants nonhypoxemic at rest reported continuous oxygen use. When compared to nonhypoxemic 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, body mass index, and FEV(1) percentage of predicted, the presence of exercise desaturation accounted for the differential mortality seen between these groups. CONCLUSIONS: In the NETT, the use of continuous oxygen in resting nonhypoxemic 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.
RCT Entities:
BACKGROUND: Continuous oxygen therapy is not recommended for emphysemapatients who are not hypoxemic at rest, although it is often prescribed. Little is known regarding the clinical characteristics and survival of nonhypoxemic emphysemapatients using continuous oxygen. Analysis of data from the National Emphysema Treatment Trial (NETT) offers insight into this population. METHODS: We analyzed demographic and clinical characteristics of 1,215 participants of NETT, stratifying by resting PaO(2) and reported oxygen use. Eight-year survival was evaluated in individuals randomized to medical therapy. RESULTS: At enrollment, 33.8% (n = 260) of participants nonhypoxemic at rest reported continuous oxygen use. When compared to nonhypoxemic 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, body mass index, and FEV(1) percentage of predicted, the presence of exercise desaturation accounted for the differential mortality seen between these groups. CONCLUSIONS: In the NETT, the use of continuous oxygen in resting nonhypoxemic emphysemapatients 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.
Authors: Roger D Yusen; Gerard J Criner; Alice L Sternberg; David H Au; Anne L Fuhlbrigge; Richard K Albert; Richard Casaburi; James K Stoller; Kathleen F Harrington; J Allen D Cooper; Philip Diaz; Steven Gay; Richard Kanner; Neil MacIntyre; Fernando J Martinez; Steven Piantadosi; Frank Sciurba; David Shade; Thomas Stibolt; James Tonascia; Robert Wise; William C Bailey Journal: Ann Am Thorac Soc Date: 2018-01
Authors: Richard K Albert; David H Au; Amanda L Blackford; Richard Casaburi; J Allen Cooper; Gerard J Criner; Philip Diaz; Anne L Fuhlbrigge; Steven E Gay; Richard E Kanner; Neil MacIntyre; Fernando J Martinez; Ralph J Panos; Steven Piantadosi; Frank Sciurba; David Shade; Thomas Stibolt; James K Stoller; Robert Wise; Roger D Yusen; James Tonascia; Alice L Sternberg; William Bailey Journal: N Engl J Med Date: 2016-10-27 Impact factor: 91.245
Authors: Deog Kyeom Kim; Francine L Jacobson; George R Washko; Richard Casaburi; Barry J Make; James D Crapo; Edwin K Silverman; Craig P Hersh Journal: Respir Med Date: 2011-03-10 Impact factor: 3.415
Authors: Minseok Seo; Weiliang Qiu; William Bailey; Gerard J Criner; Mark T Dransfield; Anne L Fuhlbrigge; John J Reilly; Mary Beth Scholand; Peter Castaldi; Robert Chase; Margaret Parker; Aabida Saferali; Jeong H Yun; James D Crapo; Michael H Cho; Terri H Beaty; Edwin K Silverman; Craig P Hersh Journal: J Mol Med (Berl) Date: 2018-10-23 Impact factor: 4.599