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Original Research: COPD |

Short-term Effects of Supplemental Oxygen on 6-Min Walk Test Outcomes in Patients With COPD: A Randomized, Placebo-Controlled, Single-blind, Crossover Trial

Inga Jarosch, MSc; Rainer Gloeckl, PhD; Eva Damm, MD; Anna-Lena Schwedhelm, MD; David Buhrow, MD; Andreas Jerrentrup, MD; Martijn A. Spruit, PhD; Klaus Kenn, MD
Author and Funding Information

Ms Jarosch and Dr Gloeckl contributed equally to this manuscript.

FUNDING/SUPPORT: The study was partly supported by ROX Medical, and study materials (gases) were provided by Linde Gas Therapeutics GmbH.

aDepartment of Respiratory Medicine and Pulmonary Rehabilitation, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany

bDepartment for Prevention, Rehabilitation and Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany

cDepartment of Pneumology and Critical Care Medicine, University of Marburg, Marburg, Germany

dDepartment of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, the Netherlands

eREVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium

fDepartment of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands

gDepartment of Pulmonary Rehabilitation, University of Marburg, Marburg, Germany

CORRESPONDENCE TO: Inga Jarosch, MSc, Department of Respiratory Medicine and Pulmonary Rehabilitation, Schoen Klinik Berchtesgadener Land, Malterhoeh 1, 83471 Schoenau am Koenigssee, Germany


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(4):795-803. doi:10.1016/j.chest.2016.11.044
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Background  The acute effect of supplemental oxygen during exercise has been shown to differ largely among patients with COPD. It is unknown what factors influence oxygen response.

Methods  In a randomized, single-blind fashion, 124 patients with COPD underwent one 6-min walk test on supplemental oxygen (6MWTO2) and one 6-min walk test on room air after a practice 6-min walk test. Both gases were delivered via standard nasal prongs (2 L/min). For analyses, patients were stratified on the basis of PaO2 values and compared: (1) 34 patients with resting hypoxemia (HYX); (2) 43 patients with exercise-induced hypoxemia (EIH); and (3) 31 patients with normoxemia (NOX).

Results  Oxygen supplementation resulted in an increase in the 6-min walk distance in the total cohort (27 ± 42 meters; P < .001) and in the subgroups of HYX (37 ± 40 meters; P < .001) and EIH (28 ± 44 meters; P < .001) but not in the NOX subgroup (15 ± 43 meters; P = .065). Forty-two percent of patients with HYX and 47% of patients with EIH improved their 6-min walk distance to a clinically relevant extent (≥ 30 meters) by using oxygen. These oxygen responders were characterized by significantly lower 6-min walk distance using room air compared with patients without a relevant response (306 ± 106 meters vs 358 ± 113 meters; P < .05). Although oxygen saturation was significantly higher during 6MWTO2 compared with the 6-min walk test on room air in all 3 subgroups, it dropped to < 88% during 6MWTO2 in 73.5% of patients with HYX.

Conclusions  In contrast to patients with NOX, patients with HYX and EIH generally benefit from supplemental oxygen by increasing exercise capacity. However, less than one-half of patients reached the threshold of clinically relevant improvements. These oxygen responders were characterized by significantly lower exercise capacity levels.

Trial Registry  ClinicalTrials.gov; No.: NCT00886639; URL: www.clinicaltrials.gov.

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