COPD: cor pulmonale: home oxygen reduced mortality in hypoxic patients

Clinical bottom line (level 1b)

  1. Patients with COPD, cor pulmonale and hypoxia who received home oxygen were less likely to die than patients who did not (NNT = 5 at 5 years) .
Medical Research Council Working Party : Lancet 1981; (8222): 681-685
Expires November 2003

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: 3 acute hospitals, UK

87 patients (aged 44 to 69; mean 58, 76% male) with chronic bronchitis or emphysema with irreversible airways obstruction (FEV1 < 1.2l) at least one episode of heart failure with ankle oedema and hypoxia (oxygen concentration 40-60 mmHg).

Excluded if
  • aged > 70
  • fibrotic or infiltrative lung disease, pneumoconiosis, severe kyphoscoliosis, overt episode of pulmonary embolism
  • severe hypertension (diastolic > 100 mmHg)
  • proven coronary artery disease
  • other life-threatening disease


    • Control Group: (n = 45, 45 analysed): no oxygen
    Experimental Group: (n = 42, 42 analysed): oxygen at least 15 hours a day via nasal prongs (to achieve a pO 2 > 60 mmHg)
    All patients could receive antibiotics, digoxin or diuretics at their physician's discretion, and all were urged to give up smoking.
    100% followed for 5 years

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    death 5 years 30
    (66.7%)    		 19
    (45.2%)    		 32%
    (0.00% to 54%)    		 21.4%
    (1.03% to 41.8%)    		 5
    (2 to 98)

    Comments

    1. Patients were randomised in blocks of four.

    Citation

    1. Medical Research Council Working Party , : long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Lancet 1981; (8222): 681-685
    Search Terms: COPD in Cochrane
    Contributor: Chris Ball and Clare Wotton, November 1999
    Reviewer: Donald Stanley

    Clinical Question.
    Patient COPD with cor pulmonale and hypoxia
    Intervention or Exposure home oxygen
    Outcome death