Inga Jarosch1, Rainer Gloeckl2, Eva Damm3, Anna-Lena Schwedhelm3, David Buhrow3, Andreas Jerrentrup3, Martijn A Spruit4, Klaus Kenn5. 1. Department of Respiratory Medicine and Pulmonary Rehabilitation, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany. Electronic address: ijarosch@schoen-kliniken.de. 2. Department of Respiratory Medicine and Pulmonary Rehabilitation, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany; Department for Prevention, Rehabilitation and Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany. 3. Department of Pneumology and Critical Care Medicine, University of Marburg, Marburg, Germany. 4. Department of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, the Netherlands; REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands. 5. Department of Respiratory Medicine and Pulmonary Rehabilitation, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany; Department of Pulmonary Rehabilitation, University of Marburg, Marburg, Germany.
Abstract
BACKGROUND: The acute effect of supplemental oxygen during exercise has been shown to differ largely among patients with COPD. It is unknown what factors influence oxygen response. METHODS: In a randomized, single-blind fashion, 124 patients with COPD underwent one6-min walk test on supplemental oxygen (6MWTO2) and one 6-min walk test on room air after a practice 6-min walk test. Both gases were delivered via standard nasal prongs (2 L/min). For analyses, patients were stratified on the basis of PaO2 values and compared: (1) 34 patients with resting hypoxemia (HYX); (2) 43 patients with exercise-induced hypoxemia (EIH); and (3) 31 patients with normoxemia (NOX). RESULTS:Oxygen supplementation resulted in an increase in the 6-min walk distance in the total cohort (27 ± 42 meters; P < .001) and in the subgroups of HYX (37 ± 40 meters; P < .001) and EIH (28 ± 44 meters; P < .001) but not in the NOX subgroup (15 ± 43 meters; P = .065). Forty-two percent of patients with HYX and 47% of patients with EIH improved their 6-min walk distance to a clinically relevant extent (≥ 30 meters) by using oxygen. These oxygen responders were characterized by significantly lower 6-min walk distance using room air compared with patients without a relevant response (306 ± 106 meters vs 358 ± 113 meters; P < .05). Although oxygen saturation was significantly higher during 6MWTO2 compared with the 6-min walk test on room air in all 3 subgroups, it dropped to < 88% during 6MWTO2 in 73.5% of patients with HYX. CONCLUSIONS: In contrast to patients with NOX, patients with HYX and EIH generally benefit from supplemental oxygen by increasing exercise capacity. However, less than one-half of patients reached the threshold of clinically relevant improvements. These oxygen responders were characterized by significantly lower exercise capacity levels. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00886639; URL: www.clinicaltrials.gov.
RCT Entities:
BACKGROUND: The acute effect of supplemental oxygen during exercise has been shown to differ largely among patients with COPD. It is unknown what factors influence oxygen response. METHODS: In a randomized, single-blind fashion, 124 patients with COPD underwent one 6-min walk test on supplemental oxygen (6MWTO2) and one 6-min walk test on room air after a practice 6-min walk test. Both gases were delivered via standard nasal prongs (2 L/min). For analyses, patients were stratified on the basis of PaO2 values and compared: (1) 34 patients with resting hypoxemia (HYX); (2) 43 patients with exercise-induced hypoxemia (EIH); and (3) 31 patients with normoxemia (NOX). RESULTS:Oxygen supplementation resulted in an increase in the 6-min walk distance in the total cohort (27 ± 42 meters; P < .001) and in the subgroups of HYX (37 ± 40 meters; P < .001) and EIH (28 ± 44 meters; P < .001) but not in the NOX subgroup (15 ± 43 meters; P = .065). Forty-two percent of patients with HYX and 47% of patients with EIH improved their 6-min walk distance to a clinically relevant extent (≥ 30 meters) by using oxygen. These oxygen responders were characterized by significantly lower 6-min walk distance using room air compared with patients without a relevant response (306 ± 106 meters vs 358 ± 113 meters; P < .05). Although oxygen saturation was significantly higher during 6MWTO2 compared with the 6-min walk test on room air in all 3 subgroups, it dropped to < 88% during 6MWTO2 in 73.5% of patients with HYX. CONCLUSIONS: In contrast to patients with NOX, patients with HYX and EIH generally benefit from supplemental oxygen by increasing exercise capacity. However, less than one-half of patients reached the threshold of clinically relevant improvements. These oxygen responders were characterized by significantly lower exercise capacity levels. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00886639; URL: www.clinicaltrials.gov.
Authors: Susan S Jacobs; Jerry A Krishnan; David J Lederer; Marya Ghazipura; Tanzib Hossain; Ai-Yui M Tan; Brian Carlin; M Bradley Drummond; Magnus Ekström; Chris Garvey; Bridget A Graney; Beverly Jackson; Thomas Kallstrom; Shandra L Knight; Kathleen Lindell; Valentin Prieto-Centurion; Elisabetta A Renzoni; Christopher J Ryerson; Ann Schneidman; Jeffrey Swigris; Dona Upson; Anne E Holland Journal: Am J Respir Crit Care Med Date: 2020-11-15 Impact factor: 21.405