Article1 September 1980

Continuous or Nocturnal Oxygen Therapy in Hypoxemic Chronic Obstructive Lung Disease

A Clinical Trial
    Author, Article, and Disclosure Information


    At six centers, 203 patients with hypoxemic chronic obstructive lung disease were randomly allocated to either continuous oxygen (O2) therapy or 12-hour nocturnal O2 therapy and followed for at least 12 months (mean, 19.3 months). The two groups were initially well matched in terms of physiological and neuropsychological function. Compliance with each oxygen regimen was good. Overall mortality in the nocturnal O2 therapy group was 1.94 times that in the continuous O2 therapy group (P = 0.01). This trend was striking in patients with carbon dioxide retention and also present in patients with relatively poor lung function, low mean nocturnal oxygen saturation, more severe brain dysfunction, and prominent mood disturbances. Continuous O2 therapy also appeared to benefit patients with low mean pulmonary artery pressure and pulmonary vascular resistance and those with relatively well-preserved exercise capacity. We conclude that in hypoxemic chronic obstructive lung disease, continuous O2 therapy is associated with a lower mortality than is nocturnal O2 therapy. The reason for this difference is not clear.


    • 1. BURROWS B and EARLE R. Course and prognosis of chronic obstructive lung disease, a prospective study of 200 patients. N Engl J Med. 1969;280:397-404. CrossrefMedlineGoogle Scholar
    • 2. LEVINE BBIGELOW D, and HAMSTRA R. The role of long-term continuous oxygen administration in patients with chronic airway obstruction with hypoxemia. Ann Intern Med. 1967;66:639-50. LinkGoogle Scholar
    • 3. PETTY T and FINIGAN M. The clinical evaluation of prolonged ambulatory oxygen therapy in patients with chronic airway obstruction. Am J Med. 1968;45:242-52. CrossrefMedlineGoogle Scholar
    • 4. ABRAHAM ACOLE R, and BISHOP J. Reversal of pulmonary hypertension by prolonged oxygen administration to patients with chronic bronchitis. Circ Res. 1968;23:147-57. CrossrefMedlineGoogle Scholar
    • 5. KROP HBLOCK A, and COHEN E. Neuropsychologic effects of continuous oxygen therapy in chronic obstructive pulmonary disease. Chest 1973;64:317-22. CrossrefMedlineGoogle Scholar
    • 6. STEWARD BHOOD C, and BLOCK A. Long term results of continuous oxygen therapy at sea level. Chest. 1975;68:486-92. CrossrefMedlineGoogle Scholar
    • 7. FLENLEY DDOUGLAS N, and LAMB D. Nocturnal hypoxemia and long term domiciliary oxygen in blue and bloated bronchitics. Chest. 1980;77:305-7. CrossrefMedlineGoogle Scholar
    • 8. KOO KSAX D, and SNIDER G. Arterial blood gases and pH during sleep in chronic obstructive lung disease. Am J Med. 1975;58:663-70. CrossrefMedlineGoogle Scholar
    • 9. STARK RFINNEGAN P, and BISHOP J. Daily requirement of oxygen to reverse pulmonary hypertension in patients with chronic bronchitis. Br Med J. 1972;3:724-8. CrossrefMedlineGoogle Scholar
    • 10. STARK RFINNEGAN P, and BISHOP J. Long-term domiciliary oxygen in chronic bronchitis with pulmonary hypertension. Br Med J. 1973;3:467-70. CrossrefMedlineGoogle Scholar
    • 11. LENFANT C. Twelve- or 24-hour oxygen therapy: why a clinical trial? JAMA. 1980;243:551-2. Editorial. CrossrefMedlineGoogle Scholar
    • 12. . Protocol for Nocturnal Oxygen Therapy Collaborative Program. Bethesda: National Institutes of Health; 1978. (Available from the National Heart, Lung, and Blood Institute.) Google Scholar
    • 13. REITAN R and DAVIDSON L. Clinical Neuropsychology: Current Status and Applications, New York: John Wiley and Sons; 1974. Google Scholar
    • 14. RUSSELL ENEURINGER C, and GOLDSTEIN G. Assessment of Brain Damage: a Neuropsychological Key Approach. New York: John Wiley and Sons; 1970. Google Scholar
    • 15. GRANT IHEATON RMCSWEENEY AADAMS K, and TIMMS R. Brain dysfunction in COPD. Chest. 1980;77 (suppl.):308-9. CrossrefMedlineGoogle Scholar
    • 16. DAHLSTROM WWELSH G, and DAHLSTROM L. An MMPI Handbook. Vol I. Minneapolis: University of Minnesota; 1972. Google Scholar
    • 17. BERGNER MBOBBIT RPOLLARD WMARTIN D, and GILSON B. The sickness impact profile: validation of health and status measure. Med Care. 1976;14:57-67. CrossrefMedlineGoogle Scholar
    • 18. WASKOW I and PARLOFF M. Psychotherapy Change Measures. Washington, D.C.: U.S. Government Printing Office; 1975. Google Scholar
    • 19. KAPLAN E and MEIER P. Non-parametric estimation from incomplete observation. J Am Statist Assoc. 1958;53:457-81. CrossrefGoogle Scholar
    • 20. COX D. Regression models and life tables. J R Stat Soc. [Series B]. 1972;35:187-220. Google Scholar
    • 21. ARMITAGE P. Sequential Medical Trials. Springfield, Illinois: Charles C Thomas; 1970. Google Scholar
    • 22. Report of the Committee for the Assessment of Biometric Aspects of Controlled Trials of Hypoglycemic Agents. JAMA. 1975;231:583-608. CrossrefMedlineGoogle Scholar
    • 23. KAY J. Effect of continuous and intermittent normoxia on chronic hypoxic pulmonary hypertension, right ventricular hypertrophy, and polycythemia in rats. Am Rev Respir Dis. 1980; in press. MedlineGoogle Scholar

    This content is PDF only. To continue reading please click on the PDF icon.