Calling Dr. Bauer …
Dear Dr. Bauer,
I am a 65-year old woman with COPD. My pulmonologist told me about recent research that indicated, at least for the popu- lation in the study, that some people with COPD might not be benefiting from oxygen therapy and don’t really need it. I am an active person, I exercise daily, eat well, and keep up with my medication and inhalers. Could you explain the research and what a practical approach to this new information might be?
Two major scientific studies in the 1970s formed the basis of our current recommendations to prescribe long-term oxygen therapy for people with COPD who have resting oxygen saturations less than 89 percent. Oxygen therapy was shown to prolong life expectancy in people with severe COPD who had low blood oxygen levels. A study entitled “A Randomized Trial of Long-Term Oxygen for Those with COPD with Moderate Desaturation” in the October 27, 2016, New England Journal of Medicine (one of the most respected medical journals) looked at people with more modest oxygen levels: resting O2 saturation between 89 percent to 93 percent or saturations that only went down with walking exercise to levels between 80 percent to 90 percent. Their findings were very interesting! After following these people for up to six years, oxygen therapy did not seem to prolong life, reduce hospitalization rates, improve exercise capacity or other measures of quality of life.
What should we make of this? We do not know if the people who participated in the study continued to smoke or not. This is certainly a very important issue since Medicare reimbursements for oxygen-related costs to COPD patients exceeds $2 billion dollars a year. Right now, you will qualify for oxygen therapy when your resting saturations go below 89 percent with exercise or if there is even modest reduction documented while sleeping. I think decisions need to be made on a very individual basis. Does oxygen help you exercise for longer distances; do you sleep better with oxygen; do you have another non-pulmonary disease, especially heart disease? These and many more considerations are important for making rational use of oxygen therapy. I suspect with upward spiraling of medical costs, more stringent restrictions in oxygen therapy are in store. Health professionals always need to advocate what is in the best interests of our patients.
Looking forward to a great 2018 for all of you!