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Khor YH, Ekström M. The benefits and drawbacks of home oxygen therapy for COPD: what's next? Expert Rev Respir Med 2024; 18:469-483. [PMID: 38984511 DOI: 10.1080/17476348.2024.2379459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/09/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Home oxygen therapy is one of the few interventions that can improve survival in patients with chronic obstructive pulmonary disease (COPD) when administered appropriately, although it may cause side effects and be an unnecessary burden for some patients. AREAS COVERED This narrative review summarizes the current literature on the assessment of hypoxemia, different types of home oxygen therapy, potential beneficial and adverse effects, and emerging research on home oxygen therapy in COPD. A literature search was performed using MEDLINE and EMBASE up to January 2024, with additional articles being identified through clinical guidelines. EXPERT OPINION Hypoxemia is common in patients with more severe COPD. Long-term oxygen therapy is established to prolong survival in patients with chronic severe resting hypoxemia. Conversely, in the absence of chronic severe resting hypoxemia, home oxygen therapy has an unclear or conflicting evidence base, including for palliation of breathlessness, and is generally not recommended. However, beneficial effects in some patients cannot be precluded. Evidence is emerging on the optimal daily duration of oxygen use, the role of high-flow and auto-titrated oxygen therapy, improved informed decision-making, and telemonitoring. Further research is needed to validate novel oxygen delivery systems and monitoring tools and establish long-term effects of ambulatory oxygen therapy in COPD.
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Affiliation(s)
- Yet H Khor
- Respiratory Research@Alfred, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Magnus Ekström
- Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Kim C, Ko Y, Lee JS, Rhee CK, Lee JH, Moon JY, Lim SY, Yoo KH, Seo JB, Oh YM, Lee SD, Park YB. High urinary desmosine is associated with long-term mortality in patients with COPD. ERJ Open Res 2023; 9:00078-2023. [PMID: 37377655 PMCID: PMC10291305 DOI: 10.1183/23120541.00078-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/06/2023] [Indexed: 06/29/2023] Open
Abstract
COPD patients with high baseline urinary desmosines demonstrated significantly higher mortality than those with lower urinary desmosines. High urinary desmosine is independently associated with an increased risk of long-term mortality in COPD patients. https://bit.ly/4015xZ9.
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Affiliation(s)
- Changhwan Kim
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
- Clinical Research Center for Chronic Obstructive Airway Diseases, Seoul, Republic of Korea
- These authors contributed equally
| | - Yousang Ko
- Clinical Research Center for Chronic Obstructive Airway Diseases, Seoul, Republic of Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
- These authors contributed equally
| | - Jae Seung Lee
- Clinical Research Center for Chronic Obstructive Airway Diseases, Seoul, Republic of Korea
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chin Kook Rhee
- Clinical Research Center for Chronic Obstructive Airway Diseases, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Hwa Lee
- Clinical Research Center for Chronic Obstructive Airway Diseases, Seoul, Republic of Korea
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Ji-Yong Moon
- Clinical Research Center for Chronic Obstructive Airway Diseases, Seoul, Republic of Korea
- Division of Pulmonology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Seong Yong Lim
- Clinical Research Center for Chronic Obstructive Airway Diseases, Seoul, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwang Ha Yoo
- Clinical Research Center for Chronic Obstructive Airway Diseases, Seoul, Republic of Korea
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Joon Beom Seo
- Clinical Research Center for Chronic Obstructive Airway Diseases, Seoul, Republic of Korea
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeon-Mok Oh
- Clinical Research Center for Chronic Obstructive Airway Diseases, Seoul, Republic of Korea
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Do Lee
- Clinical Research Center for Chronic Obstructive Airway Diseases, Seoul, Republic of Korea
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Bum Park
- Clinical Research Center for Chronic Obstructive Airway Diseases, Seoul, Republic of Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
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García-Talavera I, Figueira-Gonçalves JM, Golpe R, Esteban C, Amado C, Pérez-Méndez LI, Aramburu A, Conde-Martel A. Early Desaturation During 6-Minute Walk Test is a Predictor of Mortality in COPD. Lung 2023; 201:217-224. [PMID: 37036523 DOI: 10.1007/s00408-023-00613-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/15/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Oxygen desaturation during exercise is mainly observed in severe cases of chronic obstructive pulmonary disease (COPD) and is associated with a worse prognosis, but little is known about the type of desaturation that causes the greatest risk of mortality. MATERIAL AND METHODS We studied all of the 6-min walk tests performed periodically at a tertiary hospital over a period of 12 years in patients with moderate or severe COPD. We classified patients as non-desaturators if they did not suffer a drop in oxygen saturation (SpO2 < 88%) during the test, early desaturators if the time until desaturation was < 1 min, and non-early desaturators if it was longer than 1 min. The average length of follow-up per patient was 5.6 years. RESULTS Of the 319 patients analyzed, 126 non-desaturators, 91 non-early desaturators and 102 early desaturators were identified. The mortality analysis showed that early desaturators had a mortality of 73%, while it was 38% for non-early desaturators and 28% for non-desaturators, with a survival of 5.9 years compared to 7.5 years and 9.6 years, respectively (hazard ratio of 3.50; 95% CI 2.3-5.3; p < 0.0001). CONCLUSIONS The early desaturation seen in patients with chronic obstructive pulmonary disease is associated with greater mortality and is likely responsible for the poor prognosis shown globally in patients who desaturate. The survival of patients with early desaturation is almost 4 years less with respect to non-desaturators, and they, thus, require closer observation.
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Affiliation(s)
- Ignacio García-Talavera
- Respiratory Department, Research Unit, University Hospital Nuestra Señora de Candelaria, Tenerife, Spain.
| | - Juan Marco Figueira-Gonçalves
- Respiratory Department, Research Unit, University Hospital Nuestra Señora de Candelaria, Tenerife, Spain
- Canary Tropical Disease and Public Health Institute. La Laguna University, La Laguna, Spain
| | - Rafael Golpe
- Respiratory Department, University Hospital Lucas Augusti, Lugo, Spain
| | - Cristobal Esteban
- Respiratory Department, University Hospital Galdakao, Galdakao, Bizkaia, Spain
- BioCruces-Bizkaia Health Research Institute, Baracaldo, Spain
- Health Services Research On Chronic Patients Network (REDISSEC). Red de Investigación en Cronicidad, Atención Primaria Y Promoción de La Salud (RICAPPS), Marbella, Spain
| | - Carlos Amado
- Respiratory Deptartment, University Hospital Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Lina I Pérez-Méndez
- Department of Clinical Epidemiology and Biostatistics, Research Unit, University Hospital Nuestra Señora de Candelaria Tenerife and Primary Care Management, Santa Cruz de Tenerife, Spain
- Networked Biomedical Research Centre (CIBER) of Respiratory Diseases, Carlos III Health Institute, Madrid, Spain
| | - Amaia Aramburu
- Respiratory Department, University Hospital Galdakao, Galdakao, Bizkaia, Spain
| | - Alicia Conde-Martel
- Internal Medicine Department, University Hospital Dr Negrín, Las Palmas de Gran Canaria, Spain
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Wei Y, Giunta S, Xia S. Hypoxia in Aging and Aging-Related Diseases: Mechanism and Therapeutic Strategies. Int J Mol Sci 2022; 23:8165. [PMID: 35897741 PMCID: PMC9330578 DOI: 10.3390/ijms23158165] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 01/27/2023] Open
Abstract
As the global aging process continues to lengthen, aging-related diseases (e.g., chronic obstructive pulmonary disease (COPD), heart failure) continue to plague the elderly population. Aging is a complex biological process involving multiple tissues and organs and is involved in the development and progression of multiple aging-related diseases. At the same time, some of these aging-related diseases are often accompanied by hypoxia, chronic inflammation, oxidative stress, and the increased secretion of the senescence-associated secretory phenotype (SASP). Hypoxia seems to play an important role in the process of inflammation and aging, but is often neglected in advanced clinical research studies. Therefore, we have attempted to elucidate the role played by different degrees and types of hypoxia in aging and aging-related diseases and their possible pathways, and propose rational treatment options based on such mechanisms for reference.
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Affiliation(s)
- Yaqin Wei
- Department of Geriatrics, Shanghai Institute of Geriatrics, Huadong Hospital, Fudan University, Shanghai 200000, China;
| | - Sergio Giunta
- Casa di Cura Prof. Nobili–GHC Garofalo Health Care, 40035 Bologna, Italy;
| | - Shijin Xia
- Department of Geriatrics, Shanghai Institute of Geriatrics, Huadong Hospital, Fudan University, Shanghai 200000, China;
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Santos CD, Santos AF, das Neves RC, Ribeiro RM, Rodrigues F, Caneiras C, Spruit MA, Bárbara C. Telemonitoring of daily activities compared to the six-minute walk test further completes the puzzle of oximetry-guided interventions. Sci Rep 2021; 11:16600. [PMID: 34400715 PMCID: PMC8367992 DOI: 10.1038/s41598-021-96060-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/04/2021] [Indexed: 01/15/2023] Open
Abstract
Pulmonary rehabilitation is based on a thorough patient assessment, including peripheral oxygen saturation (SpO2) and heart rate (HR) at rest and on exertion. To understand whether exercise-field tests identify patients who desaturate (SpO2 < 90%) during physical activities, this study compared the six-minute walk test (6MWT) and daily-life telemonitoring. Cross-sectional study including 100 patients referred for pulmonary rehabilitation. The 6MWT was performed in hospital with continuous assessment of SpO2, HR, walked distance and calculated metabolic equivalent of tasks (METs). Patients were also evaluated in real-life by SMARTREAB telemonitoring, a combined oximetry-accelerometery with remote continuous assessment of SpO2, HR and METs. SMARTREAB telemonitoring identified 24% more desaturators compared with the 6MWT. Moreover, there were significant mean differences between 6MWT and SMARTREAB in lowest SpO2 of 7.2 ± 8.4% (P < 0.0005), in peak HR of - 9.3 ± 15.5% (P < 0.0005) and also in activity intensity of - 0.3 ± 0.8 METs (P < 0.0005). The 6MWT underestimates the proportion of patients with exercise-induced oxygen desaturation compared to real-life telemonitoring. These results help defining oximetry-guided interventions, such as telemedicine algorithms, oxygen therapy titration and regular physical activity assessment in pulmonary rehabilitation.
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Affiliation(s)
- Catarina Duarte Santos
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal. .,Unidade de Reabilitação Respiratória, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
| | - Ana Filipe Santos
- Unidade de Reabilitação Respiratória, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Rui César das Neves
- CAST - Consultoria e Aplicações em Sistemas e Tecnologia, Lda., Lisbon, Portugal
| | - Ruy M Ribeiro
- Laboratório de Biomatemática, Instituto de Saúde Ambiental, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Fátima Rodrigues
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Unidade de Reabilitação Respiratória, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Cátia Caneiras
- Laboratório de Microbiologia na Saúde Ambiental (EnviHealthMicroLab), Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Healthcare Department, Nippon Gases, Maia, Portugal
| | - Martijn A Spruit
- Department of Research and Development, CIRO, 6085 NM, Horn, The Netherlands.,Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6229 HX, Maastricht, The Netherlands
| | - Cristina Bárbara
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Serviço de Pneumologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
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