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Long-term oxygen therapy in COPD patients: population-based cohort study on mortality

Nikolay Pavlov, Alan Gary Haynes, Armin Stucki, et al.
Int J Chron Obstruct Pulmon Dis 2018;13:979—88

Mortality from chronic obstructive pulmonary disease (COPD) is projected to become the world’s third leading cause of mortality by 2030. Current treatment guidelines recommend the use of long-term oxygen therapy (LTOT) in COPD patients with severe chronic hypoxaemia. However, despite LTOT, survival of these patients remains poor, as severe hypoxaemia is a symptom of end-stage COPD. Few studies have addressed mortality in this subgroup of patients.

The aim of this population-based prospective cohort study by Nikolay Pavlov and colleagues was to gain a better understanding of the natural course of COPD at its end stage, and to identify those risk factors that might be modified, so as to improve patient management and give insight into novel care strategies for patients with COPD on LTOT.

The study was conducted over two years with all COPD patients receiving LTOT in Bern, Switzerland (n=771). The two-year mortality rate of COPD patients on incident LTOT was found to be somewhat lower in this study than in older cohorts, but remained high compared with the general population (especially in younger patients receiving LTOT for less than six months). The recommendation from this observation was that patients on LTOT should receive a closer follow-up in the first months, which looks at compliance, indication for oxygen therapy and dose adjustment according to blood gas analysis. Close attention should be given to type 2 respiratory failure, which was associated with mortality, while non-invasive ventilation should be considered early.

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