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The Long-Term Oxygen Treatment Trial

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The National Heart, Lung and Blood Institute (NHLBI) and the Centers for Medicare and Medicaid Services (CMS) today, announced the publication of the long awaited results from the Long-Term Oxygen Treatment Trial (LOTT) in the New England Journal of Medicine.

Long-term oxygen treatment has already been shown to improve survival and reduce hospitalizations in those with COPD and severely low levels of blood oxygen (i.e. if your saturation rate is equal to or less than 88 percent at rest). Oxygen treatment may also be prescribed if COPD patients have a “moderately low” oxygen saturation rest that falls below 90% with activity or when sleeping. Until now, there was little research that told us whether or not oxygen for this moderate group with moderately low saturation levels at rest (between 89-93 percent) and below 90 percent with activity was beneficial.

LOTT enrolled 738 people with COPD who had moderately low oxygen saturation levels at rest or during activity in a randomized clinical trial where half of the group was prescribed oxygen treatment and half was not. The study found that on average, the patients who were prescribed oxygen treatment received no additional benefit to survival, hospitalizations, worsening symptoms or to quality of life. That means that based on this study, for most COPD patients with moderately low levels of oxygen saturation, oxygen use is not beneficial. At first glance it is easy to be surprised by these results, especially as it relates to those patients who use oxygen during activity. You may fall into this group and find it hard to imagine getting on that treadmill in the morning to get in your steps without sliding on your oxygen.

While researchers, clinicians and we at the COPD Foundation take some time to examine the LOTT publication released this evening, the MOST important thing to know is that the study examined GROUP effect. That means that it measured an average effect for all those in the study and was NOT intended to assess individual responses to oxygen treatment. The decision whether to start oxygen treatment is one that should be an informed, shared decision with your healthcare provider.

Another thing to cross off the list of immediate worries is whether your oxygen will still be reimbursed by CMS. The coverage for oxygen treatment should not change as a result of this study, as current coverage already includes those whose saturation falls below 90% with activity. CMS has indicated that it does not have intentions of reevaluating their coverage standards. We will be sure to reach out to CMS as we digest the LOTT publication to ensure that they understand the importance of continuing to provide flexibility in oxygen coverage and hope that others who pay for healthcare follow their lead.

Lastly, the LOTT publication reinforces the need for investing in COPD research and public health efforts that will help prevent COPD, improve the quality of care for patients and speed the development of new treatments and one day a cure. The COPD National Action Plan will be our platform for seeking those changes over the coming years. We hope you will join us and lend your voice as advocacy activities kick off after the Plan is launched early next year.

You can read more about the LOTT results on the NHLBI website here. Let us know what questions you have as you read more about the study’s results and we will be sure to work with our research and clinical advisors to answer them throughout the week.

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  • I think it's good to have a study to assess our oxygen at rest, at exertion and sleep. From the oxymeter, my oxygen saturation at rest is 93. I never have a study to assess my oxygen. I asked my doctor about this and he said that too much oxygen can "harm" you..
    Reply
    • I've never heard this and would like to know why???
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    • Made, the comment from your doctor is related to two situations.

      1. Oxygen toxicity. This is a phenomenom that may occur in rare situations with high flow and high concentrations of oxygen. Typically, this may occur with long-term ventilator patients in the ICU. This is not associated with low flow oxygen used in teh home for treatment of COPD.

      2. The Hypoxic Drive Theory. Basically, the theory states that if patients oxygen levels are too high, then they will lose the impulse to breathe. This is rare and only thought to occur in those known to be CO2 retainers.

      This is a very controversial topic. All the evidence I have seen disproves the hypoxic drive theory and frankly that is why the theory has never moved passed "theory" in over 60 years. Unfortunately, the medical community has not embraced the evidence on this theory and it remains controversial today. What really occurs is that a patient goes into respiratory failure and it goes unrecognized because oxygen saturations are in the normal range when the patient becomes unresponsive. Sats are easy to monitor, so if it is normal HCPs thing everything is fine, but there are other assessment values that must be monitored. So, people call this the hypoxic drive effect. I call it unrecognized respiratory failure and a tragedy in patient assessment.
      Reply
  • There are a lot of issues about the trial protocol and how patients were selected, which make it difficult to determine how useful the results are to apply to the general population of COPD patients. It is clear that using pulse oximeters are useful tools in being sure to remain properly saturated at all times and avoid health risks that can be associated with being poorly saturated. It is expected that more discussion about this study and results will be released over time, as the study did cover 42 different centers.
    Reply
    • Curious, what were the issues with the study or is that what will be coming out in due time.


      Reply
    • clipper - here's a link to the complete study:

      http://www.nejm.org/doi/full/10.1056/NEJMoa1604344


      Reply
  • thank you Karen
    Reply
  • My oxygen levels fall pretty low during activity, but where-as I feel OK during relaxation and sleep periods (except late night before bedtime when my lungs are just plain tired and stressed out, and my evening dose of Symbicort doesn't work the same as my morning dose) I haven't been tested during down times for years. After many years of resistance I've finally relented and allowed my Dr. to prescribe a generator and tanks. Even though portable I find the hassle of manipulating the tanks and lines to outweigh any possible benefit, so I've not used them. The generator I use occasionally. It's vaguely comforting during instances of outright respiratory distress but it certainly doesn't achieve the glowing and optimistic prognostications as promised by the medical professionals. As it turns out Oxygen Therapy seems not to doesn't increase my capacity, absorption, endurance or capabilities and the nose piece irritates my nostrils. I've told my Dr. several times about my dissatisfaction but he lacks the ability to wrap his mind around it. I'm generally disappointed but this article provides some interesting confirmation of my personal experience. Thank you
    Reply
    • Salter has designed new cannulas that are softer for the nose and over the ears which in my opinion are MUCH more comfortable. My O2 provider, Apria provided them to me at my request at no extra charge. They are called 16SOFT-7 (7 foot long cannula). It is a significant improvement I think. It is the only cannula National Jewish uses and soon will be the only type carried by Salter.

      How low is "pretty low" that your O2 levels fall to? Do you measure with your oximeter?

      Keeping our O2 levels at least above 90% as much as possible is a good way to stay as healthy as possible and avoid complications like heart problems from our heart having to work too hard trying to keep the body oxygenated.

      It can take some time getting used to new equipment. If there is a pulmonary rehab program available, try to get referred to one to learn how to use your equipment better or if there is something that might meet your needs better.
      Reply
  • Here's a link to Salter's webpage with info about some different types of cannulas, including the softer ones. I can really feel the difference with this one and really prefer it over the older ones that were less flexible and left indentations on my face.

    https://www.salterlabs.com/flexi-soft-cannula
    Reply

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