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Cochrane Database of Systematic Reviews

Oxygène ambulatoire pour les personnes atteintes de bronchopneumopathie chronique obstructive qui ne sont pas hypoxémiques au repos

Information

DOI:
https://doi.org/10.1002/14651858.CD000238.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 24 June 2014see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Airways Group

Copyright:
  1. Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Faisal Ameer

    Correspondence to: Royal Adelaide Hospital, Adelaide, Australia

    [email protected]

  • Kristin V Carson

    Department of Medicine, University of Adelaide, The Queen Elizabeth Hospital, Adelaide, Australia

  • Zafar A Usmani

    Department of Respiratory Medicine, The Queen Elizabeth Hospital, Adelaide, Australia

  • Brian J Smith

    Department of Medicine, University of Adelaide, The Queen Elizabeth Hospital, Adelaide, Australia

Contributions of authors

Faisal Ameer is the lead investigator for this review. Contributions included completion and submission of the ‘review update registration form’ including development of the updated protocol for the review, screening and selection of studies for inclusion, data extraction, data entry, interpretation of the analysis and complete write‐up of the manuscript draft.

Kristin Carson assisted with the ‘review update registration form,’ screening and selection of studies, data extraction, data entry, interpretation of analysis and write‐up of the final manuscript.

Zafar Usmani screened and selected studies for inclusion, performed data extraction and data entry and assisted with interpretation of the analysis and write‐up of the final manuscript.

Brian Smith supervised the review update process, interpreted the analysis and assisted with write‐up of the final manuscript.

Sources of support

Internal sources

  • Respiratory Medicine Unit; The Queen Elizabeth Hospital, Australia.

External sources

  • No sources of support supplied

Declarations of interest

None known.

Acknowledgements

We would like to thank all staff at the Cochrane Airways Group, in particular Emma Welsh, Elizabeth Stovold, Emma Jackson and Chris Cates for their ongoing help and support. We also wish to thank peer reviewers for their time and valuable feedback.

Michael Greenstone was the Editor for this review and commented critically on the review.

Version history

Published

Title

Stage

Authors

Version

2014 Jun 24

Ambulatory oxygen for people with chronic obstructive pulmonary disease who are not hypoxaemic at rest

Review

Faisal Ameer, Kristin V Carson, Zafar A Usmani, Brian J Smith

https://doi.org/10.1002/14651858.CD000238.pub2

2002 Jan 21

Ambulatory oxygen for chronic obstructive pulmonary disease

Review

Felix SF Ram, Jadwiga A Wedzicha

https://doi.org/10.1002/14651858.CD000238

Differences between protocol and review

There have been several amendments between the protocol and review for this update, including:

  • Alteration to the objective of the review

  • Definition of 'long term' given as >two weeks

  • Types of participants revised as per the inclusion criteria

  • Mortality included as primary outcomes instead of secondary outcome

  • Length of stay, quality of life, adverse events and hospitalisations added as secondary outcomes

  • Search terms truncated

  • Cochrane risk of bias tool applied replacing the Jadad score

  • Statistical methodology defined with greater detail

  • Added summary of findings table

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

158 Study flow diagram.
Figures and Tables -
Figure 1

158 Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Ambulatory oxygen therapy versus placebo (air), Outcome 1 6MWD (cylinder air for 6MWD).
Figures and Tables -
Analysis 1.1

Comparison 1 Ambulatory oxygen therapy versus placebo (air), Outcome 1 6MWD (cylinder air for 6MWD).

Comparison 1 Ambulatory oxygen therapy versus placebo (air), Outcome 2 6MWD outcome (cylinder oxygen for 6MWD).
Figures and Tables -
Analysis 1.2

Comparison 1 Ambulatory oxygen therapy versus placebo (air), Outcome 2 6MWD outcome (cylinder oxygen for 6MWD).

Comparison 1 Ambulatory oxygen therapy versus placebo (air), Outcome 3 Step exercise testing (number of steps).
Figures and Tables -
Analysis 1.3

Comparison 1 Ambulatory oxygen therapy versus placebo (air), Outcome 3 Step exercise testing (number of steps).

Comparison 1 Ambulatory oxygen therapy versus placebo (air), Outcome 4 Mortality.
Figures and Tables -
Analysis 1.4

Comparison 1 Ambulatory oxygen therapy versus placebo (air), Outcome 4 Mortality.

Comparison 1 Ambulatory oxygen therapy versus placebo (air), Outcome 5 Borg score—dyspnoea (higher score worse).
Figures and Tables -
Analysis 1.5

Comparison 1 Ambulatory oxygen therapy versus placebo (air), Outcome 5 Borg score—dyspnoea (higher score worse).

Comparison 1 Ambulatory oxygen therapy versus placebo (air), Outcome 6 Arterial oxygen saturation during exercise.
Figures and Tables -
Analysis 1.6

Comparison 1 Ambulatory oxygen therapy versus placebo (air), Outcome 6 Arterial oxygen saturation during exercise.

Comparison 1 Ambulatory oxygen therapy versus placebo (air), Outcome 7 Quality of life (Chronic Respiratory Questionnaire).
Figures and Tables -
Analysis 1.7

Comparison 1 Ambulatory oxygen therapy versus placebo (air), Outcome 7 Quality of life (Chronic Respiratory Questionnaire).

Comparison 1 Ambulatory oxygen therapy versus placebo (air), Outcome 8 SpO2.
Figures and Tables -
Analysis 1.8

Comparison 1 Ambulatory oxygen therapy versus placebo (air), Outcome 8 SpO2.

Comparison 1 Ambulatory oxygen therapy versus placebo (air), Outcome 9 Adverse event.
Figures and Tables -
Analysis 1.9

Comparison 1 Ambulatory oxygen therapy versus placebo (air), Outcome 9 Adverse event.

Summary of findings for the main comparison. Ambulatory oxygen for COPD

Ambulatory oxygen for COPD

Patient or population: adults with COPD who had exertional dyspnoea but did not fulfil the criteria for long‐term oxygen treatment
Settings: home and hospital
Intervention: ambulatory oxygen

Control: placebo/medical air

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Ambulatory oxygen

Exercise capacity (5‐ or 6‐minute walking distance on cylinder air)
Follow‐up: 2 to 12 weeks

See comment

See comment

Not estimable

331
(4 studies)

Not applicable

Meta‐analysis not possible; see effects of interventions for more information

Mortality
Follow‐up: mean 12 weeks

See comment

See comment

RR 4.17
(0.48 to 36.3)

179
(2 studies)

⊕⊕⊕⊝1

Moderate

Although deaths occurred only in the intervention arm of the study (n = 3), they were not believed to be a direct result of the intervention

Quality of life (dyspnoea)
Measured on the CRQ, the output is a number from 0 to 7, where higher on the scale is better. MID is 0.5.

Follow‐up: 2 to 12 weeks

Baseline risk in control groups ranged from 2.8 to 3.7 points

Mean quality of life (dyspnoea) in the intervention groups was
0.28 higher
(0.10 to 0.45 higher)

MD 0.28 (0.10 to 0.45)

341
(4 studies)

⊕⊕⊕⊝2

Moderate

Other CRQ domains were also reported, including fatigue MD 0.14 (95% CI 0.04 to 0.31; P value 0.009), emotional function MD 0.10 (95% CI ‐0.05 to 0.25; P value 0.20) and mastery MD 0.13 (95% CI ‐0.06 to 0.33; P value 0.17)

Dyspnoea
Follow‐up: 6 to 12 weeks

See comment

See comment

Not estimable

198
(3 studies)

Not applicable

Meta‐analysis not possible

Dyspnoea was measured in 3 studies using the Borg scale, and 1 study reported dyspnoea during exercise. One study observed improvement in dyspnoea after walking for 6 minutes with cylinder air or oxygen. Another study showed a clinically relevant reduction in dyspnoea scores for the oxygen group post 5MWD compared with placebo

Adverse events
Follow‐up: mean 12 weeks

146 per 1000

117 per 1000
(35 to 325)

OR 0.77
(0.21 to 2.81)

83
(2 studies)

⊕⊕⊝⊝
low1,3

Only 1 of the adverse events appeared related to the intervention; this was strain due to carrying the cylinder

Hospitalisations

See comment

See comment

Not estimable

0
(0)

See comment

No studies reported data on hospitalisations

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
5MWD: 5‐Minute Walking Distance test; CI: Confidence interval; COPD: Chronic obstructive pulmonary disease; CRQ: Chronic Respiratory Disease Quesionnaire; MD: Mean difference; MID: Minimally important difference; OR: Odds ratio; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Imprecision

2 Unclear risk for selection bias in 2 studies, attrition bias in 2 studies and selective reporting in 3 studies

3 Unclear risk of selection bias, attrition bias and selective reporting in 1 study

Figures and Tables -
Summary of findings for the main comparison. Ambulatory oxygen for COPD
Comparison 1. Ambulatory oxygen therapy versus placebo (air)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 6MWD (cylinder air for 6MWD) Show forest plot

2

Odds Ratio (Fixed, 95% CI)

1.05 [0.62, 1.75]

2 6MWD outcome (cylinder oxygen for 6MWD) Show forest plot

1

Odds Ratio (Fixed, 95% CI)

Totals not selected

3 Step exercise testing (number of steps) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4 Mortality Show forest plot

2

179

Risk Ratio (M‐H, Fixed, 95% CI)

4.17 [0.48, 36.32]

5 Borg score—dyspnoea (higher score worse) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5.1 During 6MWD

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 During step exercise test

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Arterial oxygen saturation during exercise Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

6.1 During 6MWD

1

52

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐1.56, 0.36]

6.2 During step exercise test

1

52

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐2.32, 1.12]

7 Quality of life (Chronic Respiratory Questionnaire) Show forest plot

4

Mean Difference (Fixed, 95% CI)

Subtotals only

7.1 CRQ—dyspnoea

4

Mean Difference (Fixed, 95% CI)

0.28 [0.10, 0.45]

7.2 CRQ—fatigue

4

Mean Difference (Fixed, 95% CI)

0.17 [0.04, 0.31]

7.3 CRQ—emotional function

4

Mean Difference (Fixed, 95% CI)

0.10 [‐0.05, 0.25]

7.4 CRQ—mastery

4

Mean Difference (Fixed, 95% CI)

0.13 [‐0.06, 0.33]

8 SpO2 Show forest plot

2

136

Mean Difference (IV, Fixed, 95% CI)

6.52 [5.21, 7.83]

8.1 During exercise

1

54

Mean Difference (IV, Fixed, 95% CI)

6.0 [4.11, 7.89]

8.2 Post 6MWD

1

82

Mean Difference (IV, Fixed, 95% CI)

7.0 [5.18, 8.82]

9 Adverse event Show forest plot

2

83

Odds Ratio (M‐H, Fixed, 95% CI)

0.77 [0.21, 2.81]

Figures and Tables -
Comparison 1. Ambulatory oxygen therapy versus placebo (air)