COPD: pulmonary hypertension, low FEV 1 and old age increased the risk of dying on long-term oxygen therapy

Clinical bottom line (level 1b)

  1. One in five patients with COPD requiring home oxygen therapy were dead within 24 months.
  2. The risk of dying was increased with
    • elevated right ventricular systolic pressure
    • FEV1 < 30% predicted
    • age > 70
Dallari et al: Respiration 1994; 61: 8-13
Expires November 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: 4 acute hospitals, Italy

166 patients (aged 44 to 86; mean 69, 73% male) with COPD requiring long-term oxygen therapy

Excluded if
  • associated other chest disease (cardiac disease, kyphoscoliosis, pulmonary fibrosis)


    • All patients received oxygen.

    Cox proportional regression analysis used to adjust for confounding factors

    100% followed for 2 to 50 months; mean 24 months
    Outcomes studied:
  • death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    death 24 months 36/166 22%
    (15% to 28%)    		 5
    (4 to 6)

    • Mortality was independently associated with
      • right ventricular systolic pressure (on Doppler) > 35 mmHg
      • age > 70
      • FEV1 < 30% predicted

    Comments

    1. No odds ratios were given for the independent factors.

    Citation

    1. Dallari R, Barozzi G, Pinelli G, et al: predictors of survival in subjects with chronic obstructive pulmonary disease treated with long-term oxygen therapy. Respiration 1994; 61: 8-13
    Contributor: Chris Ball and Clare Wotton, November 1999
    Reviewer: Mitsuhiro Kamei

    Clinical Question.
    Patient COPD on long-term oxygen
    Intervention or Exposure respiratory function, age
    Outcome death