Study Finds Long-Term Oxygen Unnecessary for Severe Hypoxemia in COPD Patients

Researchers indicate that current 24-hour hypoxemia oxygen treatment recommendations, based on studies done in the 1970s, are now outdated.

People who suffer from conditions like chronic obstructive pulmonary disease (COPD) or pulmonary fibrosis, which result in low blood oxygen levels, do not benefit from long periods of oxygen treatment, according to the findings of a new study.

In a report published earlier this month in The New England Journal of Medicine researchers indicate that patients with low oxygen levels in the blood, also known as hypoxia, do not experience improved breathing or lowered heart rate when they are treated with oxygen for 24 hours per day, when compared to receiving it only 15 hours per day. Both groups faced the same rate of hospitalization and death, the study found.

COPD is a lung disease that causes phlegm and difficulty breathing. It is often preceded by emphysema, and typically caused by years of smoking or chronic exposure to chemicals. When the disease progresses, it often causes severe breathing problems.

Patients are often initially treated with rescue inhalers and steroids, but may eventually need oxygen treatment to breathe. This medical intervention is needed because damage to the lungs cannot be reversed.

More than one million patients who have COPD are prescribed long-term oxygen therapy following research from the 70s, which indicated patients with COPD and severe hypoxemia benefited the most if they receive at least 24 hours of oxygen therapy.  However, these new findings suggest that recommendation may be outdated.

In this new study, Swedish researchers led by Dr. Magnus Ekström compared 24-hour treatment with 15-hour treatment for COPD and pulmonary fibrosis, in a multicenter randomized control trial from 2018 to 2022. They randomized 241 patients to undergo either 24 hours of therapy or 15 hours of therapy.

Overall, the risk of death was even in both groups, with 124 deaths per 100 years in each group. The risk of hospitalization was also the same at 64% and 63%, which included hospitalization for any cause. Additionally, the side effects patients experienced—breathlessness and fatigue—were similar in both groups.

But overall, the data indicates patients who had oxygen therapy for 15 hours per day had a lower risk of hospitalization and death compared to the 24-hour group.

More so, most patients said they preferred 15 hours per day of therapy compared to 24 hours. Researchers said most patients who have COPD are frail and struggle with oxygen therapy because the equipment can be large, heavy, and difficult for many patients to move and operate. It can also be isolating for some patients, so they may prefer fewer hours of therapy.

“Among patients with severe hypoxemia, long-term oxygen therapy used for 24 hours per day did not result in a lower risk of hospitalization or death within 1 year than therapy for 15 hours per day,” the researchers concluded.

Using oxygen therapy for fewer hours each day, especially if those hours are done during the night to help reduce the level of care needed by other caregivers, can help encourage patients to use the oxygen for longer periods of months, they determined.