For many COPD patients, oxygen
barely relieves symptoms and does nothing to improve
quality of life. That's the conclusion of a Canadian
study in the August 15 American Journal of Respiratory
and Critical Care Medicine. "Those patients can
be spared the cost and inconvenience, not to mention
the awkward feelings associated with carrying the oxygen
tank around," says lead author Dr Roger Goldstein, respirologist
at Toronto's West Park Healthcare Centre.
Current guidelines recommend oxygen
prescriptions for chronic obstructive pulmonary disease
(COPD) based on exercise tests. But these tests don't
necessarily reflect the patient's real-life activities,
and therefore the results won't translate into actual
benefits, according to Dr Goldstein's study.
In an accompanying editorial, Johns
Hopkins lung experts Dr Bradley Drummond and Dr Robert
Wise hail the study for "challenging those of us who
prescribe oxygen to explore the intricacies of real-world
activity levels of our patients."
This is no piddling problem. The
costs associated with this therapy are enormous. COPD
is the fourth leading cause of death in Canada. An estimated
750,000 Canadians suffer from this incurable and progressive
condition, which includes emphysema and chronic bronchitis.
Nearly a third of them are being prescribed oxygen therapy,
according to a report in the Globe and Mail.
In Ontario alone, this adds up to over $60 million a
year spent on oxygen. "If you can save one inappropriate
prescription, that's $400 a month," says Dr Goldstein.
"There are huge cost savings to doing this properly."
TAILOR-MADE
TREATMENT
The best way to proper oxygen prescribing is individualized
testing, according to Dr Goldstein. That's what he and
his team did in their study. Researchers followed 27
patients in individual randomized controlled trials
during three pairs of 2-week home treatment periods.
Patients were given oxygen for two weeks, then switched
to compressed air for the other two weeks. At the end
of every period, the patients went through a five minute
walking test and answered quality of life questionnaires.
Aside from the exercise test, where oxygen did bring
an improvement in endurance — patients were able
to walk seven instead of five minutes — there was
no difference in the patients' quality of life between
the oxygen and the placebo periods.
This exposes another facet of living
with COPD that docs sometimes overlook on their way
to an oxygen prescription. There's a big difference
between what a patient is able to do and what a patient
actually does. Studies have shown that COPD patients
tend to adopt an inactive lifestyle, out of fear of
triggering a respiratory attack. Most patients in the
study were only using their oxygen for about 40 minutes
a day. A patient who really needs oxygen would be using
it up to 15 hours per day.
Dr Goldstein thinks his tailor-made
approach is a better way to go. Although it requires
a visit to a respirologist, takes longer and the test
is costly — about $1,700 per patient — in
the long run, it's worth it, insists Dr Goldstein. It's
still considerably cheaper than doling out unnecessary
oxygen therapy, he says, and it would ensure that only
those who need it are getting it.
Of course, some COPD patients really
do need oxygen. Those with low O2 levels at rest are
prime candidates. "For those patients, oxygen is lifesaving,"
says Dr Goldstein. "And the more hours they're on the
treatment, the better." Others might only need it for
doing strenuous physical activities or for sleeping.
For the rest, the best therapy is a combination of meds,
lung rehab and bronchodilators.
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