Fig. 30:  This Figure highlights some of these controversies regarding oxygen therapy in COPD, based on the conclusions of an NHLBI expert panel that was convened over a decade ago to look at the effects of oxygen therapy.  Since there have been so few good studies done in the interim and no good studies have looked at morality in the last 30 years, this consensus paper still holds weight in terms of their conclusion.^[21] 

The panel’s first conclusion was that there is an arbitrariness in the clinical guidelines in that the patient group who currently receive coverage for oxygen therapy by the Centers of Medicare and Medicaid Services (CMS) is vastly different from the group that had the benefits of oxygen therapy shown on mortality from the Nocturnal Oxygen Treatment Trial (NOTT). 

Secondly, the paucity, the size, and the age of the existing studies are striking.  There have been only four prospective randomized control trials have looked at long-term oxygen therapy on mortality, none of them has been done in the last 30 years, and overall they only involved 500 subjects with few of them being women – and no positive results have been recorded since 1981.  We have limited knowledge regarding the duration and timing of oxygen use.  We prescribe it to be used 24/7 but as shown in the preceding Figures, patients do not use it 24/7, and the studies that look at supplemental oxygen use only during physical activity or on demand are even more limited.  

Finally, regarding the availability or the type of oxygen devices, there are few scientific data to guide physicians and patients regarding the preferred method of oxygen delivery, the type of device, or the duration of the device to use that would show what is the most efficacious way to improve our patients’ outcomes.