慢阻肺的长期家庭氧疗
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?MRC trial: MRC trial Lancet 1981; 1: 681
n=42, < 70 yrs, severe COPD under O 2 15 hrs/day vs. 42 patients without O 2
?Cooper et al (1987): Thorax 1987; 42: 105
Major references
?NOTT trial: NOTT trial, Ann Intern Med 1980; 93: 391
n=203 severe COPD, Mean age : 65 yrs O 2 12 hrs/24 vs. ? continuous ? (19 hrs/24)
COT (> 19 hrs/day)
60
40
NOT
12 hrs/day
20
MRC O 2 15 hrs/day MRC controls
0 0 10 20 30 40 50 60 70
Conclusions based on the MRC and NOTT trials
? 12 hours of O 2 /day is not better than no O
Home long term oxygen therapy (LTOT): Indications
Patients in a stable clinical condition with optimal bronchodilator therapy and: PaO 2 ? 55 mm Hg (7.3 kPa) or PaO 2 ? 60 mm Hg (8.0 kPa) if:
LTOT in older patients with chronic respiratory failure
? Indications
– COPD – Interstitial lung diseases – Sequellae of tuberculosis – Severe Bronchiectasis – Pulmonary vascular diseases – Central apneas (Cheyne-Stokes breathing)
Home oxygen therapy in older patients
? The NOTT and MRC study clearly show a benefit on survival for patients treated by LTOT ? No study however has shown a decrease in the number of exacerbations, or hospital stays as a concequence of LTOT ? Impact of LTOT on QoL and cognitive function appears at most very modest
80
COT (> 19 hrs/day)
60
40
NOT
12 hrs/day
20
MRC controls
0 0 10 20 30 40 50 60 70
MRC trial Lancet 1981; 1: 681
100
NOTT trial, Ann Intern Med 1980; 93: 391
80
MRC trial Lancet 1981; 1: 681 100
80
60
43%
MRC O 2 15 hrs/day
40
MRC controls
20
28%
0 0 10 20 30 40 50 60 70
100
NOTT trial, Ann Intern Med 1980; 93: 391
80
60
n=72, Mean age : 60 yrs , under O 2 12 yrs vs historical controls
MRC trial Lancet 1981; 1: 681 100
80
60
40
MRC controls
20
0 0 10 20 30 40 50 60 70
Leabharlann Baidu
MRC trial Lancet 1981; 1: 681 100
80
60
MRC O 2 15 hrs/day
40
MRC controls
20
0
0 10 20 30 40 50 60 70
MRC trial Lancet 1981; 1: 681 100
80
60
MRC O 2 15 hrs/day
40
MRC controls
20
0
0 10 20 30 40 50 60 70
Home oxygen therapy in older patients
? The NOTT and MRC study clearly show a benefit on survival for patients treated by LTOT ? No study however has shown a decrease in the number of exacerbations, or hospital stays as a concequence of LTOT
40
NOT
12 hrs/day
20
0 0 10 20 30 40 50 60 70
100
NOTT trial, Ann Intern Med 1980; 93: 391
80
60
40
NOT
12 hrs/day
20
MRC controls
0 0 10 20 30 40 50 60 70
100
NOTT trial, Ann Intern Med 1980; 93: 391
– Hematocrit > 55 % or – Edema of lower limbs or – ECG signs of cor pulmonale
Home oxygen therapy in older patients
? The NOTT and MRC study clearly show a benefit on survival for patients treated by LTOT
2!
? 15 hours of O 2 /day is the minimal threshold for a significant benefit on survival
? 19 hours of O 2 /day (COT) is better than 15 hours of O 2
? In the MRC trial, it takes about 2 years to detect a measurable effect of LTOT on survival...
n=42, < 70 yrs, severe COPD under O 2 15 hrs/day vs. 42 patients without O 2
?Cooper et al (1987): Thorax 1987; 42: 105
Major references
?NOTT trial: NOTT trial, Ann Intern Med 1980; 93: 391
n=203 severe COPD, Mean age : 65 yrs O 2 12 hrs/24 vs. ? continuous ? (19 hrs/24)
COT (> 19 hrs/day)
60
40
NOT
12 hrs/day
20
MRC O 2 15 hrs/day MRC controls
0 0 10 20 30 40 50 60 70
Conclusions based on the MRC and NOTT trials
? 12 hours of O 2 /day is not better than no O
Home long term oxygen therapy (LTOT): Indications
Patients in a stable clinical condition with optimal bronchodilator therapy and: PaO 2 ? 55 mm Hg (7.3 kPa) or PaO 2 ? 60 mm Hg (8.0 kPa) if:
LTOT in older patients with chronic respiratory failure
? Indications
– COPD – Interstitial lung diseases – Sequellae of tuberculosis – Severe Bronchiectasis – Pulmonary vascular diseases – Central apneas (Cheyne-Stokes breathing)
Home oxygen therapy in older patients
? The NOTT and MRC study clearly show a benefit on survival for patients treated by LTOT ? No study however has shown a decrease in the number of exacerbations, or hospital stays as a concequence of LTOT ? Impact of LTOT on QoL and cognitive function appears at most very modest
80
COT (> 19 hrs/day)
60
40
NOT
12 hrs/day
20
MRC controls
0 0 10 20 30 40 50 60 70
MRC trial Lancet 1981; 1: 681
100
NOTT trial, Ann Intern Med 1980; 93: 391
80
MRC trial Lancet 1981; 1: 681 100
80
60
43%
MRC O 2 15 hrs/day
40
MRC controls
20
28%
0 0 10 20 30 40 50 60 70
100
NOTT trial, Ann Intern Med 1980; 93: 391
80
60
n=72, Mean age : 60 yrs , under O 2 12 yrs vs historical controls
MRC trial Lancet 1981; 1: 681 100
80
60
40
MRC controls
20
0 0 10 20 30 40 50 60 70
Leabharlann Baidu
MRC trial Lancet 1981; 1: 681 100
80
60
MRC O 2 15 hrs/day
40
MRC controls
20
0
0 10 20 30 40 50 60 70
MRC trial Lancet 1981; 1: 681 100
80
60
MRC O 2 15 hrs/day
40
MRC controls
20
0
0 10 20 30 40 50 60 70
Home oxygen therapy in older patients
? The NOTT and MRC study clearly show a benefit on survival for patients treated by LTOT ? No study however has shown a decrease in the number of exacerbations, or hospital stays as a concequence of LTOT
40
NOT
12 hrs/day
20
0 0 10 20 30 40 50 60 70
100
NOTT trial, Ann Intern Med 1980; 93: 391
80
60
40
NOT
12 hrs/day
20
MRC controls
0 0 10 20 30 40 50 60 70
100
NOTT trial, Ann Intern Med 1980; 93: 391
– Hematocrit > 55 % or – Edema of lower limbs or – ECG signs of cor pulmonale
Home oxygen therapy in older patients
? The NOTT and MRC study clearly show a benefit on survival for patients treated by LTOT
2!
? 15 hours of O 2 /day is the minimal threshold for a significant benefit on survival
? 19 hours of O 2 /day (COT) is better than 15 hours of O 2
? In the MRC trial, it takes about 2 years to detect a measurable effect of LTOT on survival...