The Johns Hopkins University School of Medicine Baltimore, MD
Correspondence to: M. Bradley Drummond, MD, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, JHAAC 4B.70, Baltimore, MD 21224; 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).
We thank Garcia-Talavera and colleagues for their interest in our article published in CHEST (September 2008).1 Our retrospective analysis of the National Emphysema Treatment Trial (NETT) demonstrated that participants with resting normoxia and exercise desaturation had worse disease severity and survival than those without exercise desaturation, despite the use of continuous supplemental oxygen. Garcia-Talavera and colleagues commented that the indication for oxygen therapy was not fully described in our report. Per the NETT protocol, exercise desaturation was determined by a treadmill walking test conducted prior to the 6-min walk test, not by monitoring during the 6-min walk test. The time to desaturation on the treadmill test was collected; however, we did not analyze these data.
Importantly, participants in the NETT could receive oxygen prescriptions through rehabilitation centers or their primary care physician, thus making it difficult to collect specific information on the indications for oxygen therapy. In this sense, the NETT mimicked the challenges of monitoring oxygen prescription in the course of routine clinical practice, where oxygen therapy can be initiated by many different health-care providers.
Studies such as that performed by Garcia-Talavera and colleagues2 will advance our understanding of the role of oxygen therapy in patients who fall outside of established indications. The findings of our analysis emphasize the need for prospective clinical trials to characterize the factors that predict which COPD patients may benefit from supplemental oxygen. From such studies we may eventually refine our current indications for oxygen therapy.
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