Respiratory Department, Research Unit Hospital Universitario Candelaria Tenerife, Spain
Correspondence to: Ignacio García-Talavera, MD, Candelaria Hospital, El Rosario 145, Santa Cruz, Spain 38010; e-mail: email@example.com
The authors have no conflicts of interest to disclose.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).
I read with utmost interest the article by Drummond et al1 recently published in CHEST (September 2008). After a retrospective analysis, the authors confirm that patients with COPD who are hypoxia free at rest but have desaturation during exercise are at higher risk than those who do not have desaturation in spite of the fact that continuous oxygen therapy is not followed by a significant survival improvement when compared to a group without oxygen therapy. The problem is that the authors do not explain why oxygen therapy was indicated and, what is more important, they did not analyze the desaturation time in the 6-min walking test.
Our recently published article2 showed that only those patients with a time to desaturation of 1 min (early desaturators) also desaturate during the 24-h oximetry. However, late desaturators (patients with a time to desaturation > 3 to 30 min) do not have desaturation during a 24-h oximetry. It could thus very well be that the patients of Drummond et al1 were late desaturators in whom oxygen therapy may not have produced the benefit it provides to early desaturators.
Finally, although Gorecka et al3 did not find any improvement in the survival rate of patients with COPD and moderate hypoxia treated with oxygen therapy, they did not analyze the desaturation during the walking test either. At any rate, the effects of oxygen therapy in patients with COPD, normoxemia at rest, and early desaturation in the 6-min walking test remain to be evaluated.
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