SEPTEMBER 15, 2007


Oxygen over-used for COPD

Tanks costly, cumbersome and often useless, says study

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."

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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