Supplemental Oxygen May Not Always Be the Best COPD Treatment

Supplemental oxygen is part of the standard and accepted treatment methods for people who have COPD. However, oxygen may not be the best choice for people who are still in the mild to moderate stages of COPD.

A study published in the New England Journal of Medicine (NEJM) in October 2016 described a study that questioned the benefits of long-term oxygen therapy in people whose blood oxygen levels were still fairly high.¹

Benefits of supplemental oxygen therapy

We need oxygen to live. But people who have COPD often do not get enough oxygen to properly fuel their cells and bodily functions. COPD lungs may not able to effectively absorb enough oxygen from room air.

For this reason, supplemental oxygen therapy is a commonly prescribed treatment for COPD sufferers. Sometimes, it is used on only an “as needed” basis, while other times it may be used continuously.

Oxygen can be delivered as compressed gas or in liquid form. Concentrators that draws oxygen from room air are another choice.

The traditionally accepted benefits of supplemental oxygen include:

• Easier breathing
• Improved quality of life
• Extension of life expectancy
• Better mood
• Improved sleep
• Less anxiety
• Improved activity tolerance

But is it clear this is always the case for every person with COPD?

Details of the Johns Hopkins Study

On October 27, 2016, Robert Wise, MD, from Johns Hopkins University School of Medicine’s Division of Pulmonary and Critical Care Medicine, published a study in the NEJM. The study questioned conventional wisdom about oxygen therapy for COPD patients with "less severe oxygen deficiency."¹ Here are a few of the details:

• Oxygen treatment outcomes examined
• 738 patients with moderately low blood oxygen levels
• Patients were from 42 different treatment centers
• 133 patients had resting oxygen deficiency
• 319 had only exercise-induced oxygen deficiency
• 268 had both resting and exercise-induced oxygen deficiency
• Study ran for 16 months

Moderate oxygen deficiency was defined as:

• Having a blood oxygen saturation between 89 and 93 percent at rest or --
• Having a blood oxygen saturation below 90 percent during a six-minute walk test

Healthy blood oxygen levels fall between 94 and 99 percent. These blood levels measure how much oxygen your red blood cells are carrying and how your lungs are functioning. Low blood levels are a hallmark of COPD.

About half of the participants received supplemental oxygen, while the other half did not. All of the study participants received follow-up exams. They all also completed both telephone interviews and mailed questionnaires regarding their symptoms and health care use.

Study results

The results definitely suggested that supplemental oxygen is not an essential treatment approach for those with moderately low oxygen deficiency.¹ In fact, Dr. Wise stated, “No matter what measure we looked at, it made no apparent difference whether a patient with moderate oxygen deficiency received long-term oxygen treatments or not. I think the evidence is strong and shows that some patients may not need those treatments at all." ¹

These were the measurements used in the study:

• Hospitalization rates
• Death rates
• COPD exacerbations (sudden worsening of symptoms)
• Self-reported quality of life
• Lung function
• Measures of walk distance

The results were much the same between the oxygen users and the oxygen non-users. This was true even when researchers controlled for variables such as total hours of oxygen use, race, sex and smoking status.

In summary

It's important to understand two things when reading about this study:

• Supplemental oxygen therapy is still a valid treatment, with proven benefits, for many people who have COPD, particularly those with severe oxygen deficiency.
• Anyone who is already on oxygen therapy should not discontinue it if it seems to be helping.

If you're already on oxygen, you may find that you can do more and feel better with oxygen. But, oxygen therapy can also be expensive and inconvenient. Medicare reimbursements for oxygen-related costs for COPD patients from 2009 to 2011 alone were more than $2 billion per year. And oxygen equipment can be heavy and awkward to cart around or to fit into a home. Accidents tripping over tubing or because of the fire hazard sometimes cause more problems.

However, keep in mind that, "The benefits of long-term oxygen supplements for COPD patients with severe oxygen deficiency are clear," according to lead researcher, Robert Wise, M.D.

If you're not sure if oxygen is right for you, take the time to discuss it openly and honestly with your health care team. If you're on oxygen, do you feel as though it has helped you?