Domiciliary oxygen for chronic obstructive pulmonary disease

Abstract

Domiciliary oxygen therapy has become one of the major forms of treatment for hypoxaemic chronic obstructive pulmonary disease (COPD) patients. To determine the effect of domiciliary oxygen therapy on survival and quality of life in patients with COPD. Randomised controlled trials (RCTs) were identified using the Cochrane Airways Group COPD register using the search terms: home OR domiciliary AND oxygen. Searches were current as of January 2007. Any RCT in patients with hypoxaemia and COPD that compared long term domiciliary or home oxygen therapy with a control treatment. Data extraction was performed independently by two reviewers. Six randomised controlled trials were identified. Survival data were aggregated from two trials of the treatment of nocturnal oxygen therapy in patients with mild to moderate COPD and arterial desaturation at night. Survival data was also aggregated from two trials of continuous oxygen therapy versus no oxygen therapy in mild to moderate COPD. Data could not be aggregated for the other two trials because of differences in trial design and patient selection. Nott 1980: continuous oxygen therapy versus nocturnal oxygen therapy: there was a significant improvement in mortality after 24 months (Peto odds ratio 0.45, 95% confidence interval 0.25 to 0.81). MRC 1981: domiciliary oxygen therapy versus no oxygen therapy: there was a significant improvement over five years in mortality in the group receiving oxygen therapy (Peto odds ratio 0.42, 95% confidence interval 0.18 to 0.98). In the two studies of nocturnal oxygen versus no oxygen therapy in patients with COPD and arterial desaturation at night: there was no difference in mortality between treated and non treated groups for either trial or when the trials were aggregated. In the two trials of long‐term oxygen therapy versus no oxygen therapy in COPD patients with mild to moderate hypoxaemia: there was no effect on survival for up to three years of follow up. Long‐term home oxygen therapy improved survival in a selected group of COPD patients with severe hypoxaemia (arterial PaO₂ less than 55 mm Hg (8.0 kPa)). Home oxygen therapy did not appear to improve survival in patients with mild to moderate hypoxaemia or in those with only arterial desaturation at night. 以居家氧氣療法治療慢性阻塞性肺病(COPD) 居家氧氣療法已成為一個治療慢性阻塞性肺疾病低氧血症(COPD)患者的主要方法 決定家居氧治療對慢性阻塞性肺病患者的存活與生活品質的療效 我們使用了以下的搜索條件在Cochrane Airways Group COPD Register搜尋隨機對照試驗(RCT)：家庭或家居及氧氣(home OR domiciliary AND oxygen)。目前的搜尋到2007年1月。 任何低氧血症和慢性阻塞性肺病患者的隨機對照試驗,比較家居(或家庭)長期氧療以及對照治療。 數據萃取是由兩名審查員獨立進行。 我們找出了6個隨機對照試驗。我們匯總了兩個試驗的存活資料。這兩個試驗使用夜間氧療治療夜間輕度至中度慢性阻塞性肺病和動脈血氧飽和度不足的患者。我們還匯總另外兩個存活試驗的數據。這兩個試驗比較持續氧氣治療與不氧治療來治療輕度至中度慢性阻塞性肺病。因為試驗設計的差異和病人的選擇方法, 我們無法無法匯總其他兩項試驗的資料。諾特1980年：連續氧療與夜間氧療比較：死亡率在24個月有顯著改善(佩托勝算比為0.45，95％信賴區間為0.25至0.81)。醫學研究理事會(MRC)1981年：家庭氧療與無氧治療：接受氧氣治療5年以上的死亡率有顯著改善(佩托勝算比0.42，95％信賴區間為0.18至0.98)。在兩項比較夜間氧療與非氧療治療慢性阻塞)。在兩項比較夜間氧療與非氧療治療慢性阻塞性肺病和夜間低動脈血氧飽和度患者的研究中：死亡率在兩個試驗中的治療組和非治療或是匯總的結果沒有差異性。在這兩個測試長期氧氣治療與不氧治療慢性阻塞性肺病患者輕度至中度低氧血症的研究中：長達年的追蹤顯示對存活沒有影響。 長期家庭氧療可以改善特定具有嚴重低氧血症的慢性阻塞性肺病患者的存活率動脈氧分壓小於毫米汞柱千帕。居家氧氣治療並沒有改善輕至中度低氧血症患者的存活長度或是那些在夜間有低動脈血氧飽和度患者的存活長度。 本摘要由臺北醫學大學萬芳醫院楊璧如翻譯。 此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。 長期家庭的夜間氧療可以增加低動脈血氧飽和度的慢性阻塞性肺病患者的存活率。有些人患有慢性阻塞性肺病 (COPD  慢性支氣管炎或肺氣腫其血氧濃度低。氧含量低可能是一直如此，或只在夜間睡眠時呼吸變慢時發生。有些人在晚上在家裡使用瓶裝氧氣，來改善他們的呼吸。在這次試驗回顧中發現，有慢性阻塞性肺病和血氧水平低的患者這樣做，長遠來說可以提高他們的存活長度。但是，它對於那些氧氣含量只有中低，或只在夜間比較低的人沒有延長他們的存活長度。