Does Long-Term Oxygen Help COPD Patients with Moderate Low Oxygen Levels?
No. This landmark trial of 738 COPD patients found that long-term supplemental oxygen did not reduce death or hospitalization rates for patients with moderate oxygen desaturation. There was also no benefit for quality of life, lung function, or walking distance.
For decades, doctors have prescribed oxygen therapy to COPD patients with moderately low oxygen levels, assuming it would help. This large trial from the New England Journal of Medicine tested whether that assumption was correct.
What the Data Show
The Long-Term Oxygen Treatment Trial (LOTT) followed 738 patients for 1-6 years:
- Death or hospitalization: No significant difference between groups (hazard ratio 0.94, P=0.52)
- All hospitalizations: No difference (rate ratio 1.01)
- COPD exacerbations: No difference (rate ratio 1.08)
- COPD-related hospitalizations: No difference (rate ratio 0.99)
- Quality of life measures: No consistent differences
- Lung function: No significant differences
- 6-minute walk distance: No significant differences
The oxygen group used oxygen an average of 13.6 hours per day, compared to 1.8 hours in the control group. Despite this large difference in usage, outcomes were identical.
Dr. Kumar’s Take
This is one of the most important oxygen therapy studies ever published. It challenges decades of practice. The finding that 24-hour or exercise-only oxygen doesn’t help COPD patients with moderate desaturation is surprising but consistent across every outcome measured. The key distinction is between moderate and severe desaturation. Patients with severe low oxygen (below 88%) still benefit from oxygen therapy based on older studies. This trial shows we shouldn’t automatically extend that benefit to patients with higher oxygen levels.
Study Design
This was a large, multicenter trial with excellent follow-up:
- 738 patients at 42 centers across the United States
- Two types of patients: Those with moderate resting desaturation (89-93% oxygen) and those who desaturated only during exercise
- Random assignment: Half received supplemental oxygen, half did not
- Follow-up: 1-6 years (median 18.4 months)
- Oxygen prescription: 24-hour oxygen for resting desaturation, or exercise/sleep oxygen only
Why This Matters
Medicare spent over $2 billion on oxygen-related costs for COPD patients in 2011. Many of these patients may have had moderate rather than severe desaturation. This trial suggests that some of this spending may not improve patient outcomes.
The trial also found no benefit in subgroups defined by:
- Type of oxygen prescription (24-hour vs exercise/sleep)
- Severity of exercise desaturation
- Age, sex, or smoking status
- Lung function or disease severity scores
Important Context
Earlier trials from the 1970s showed clear survival benefits for oxygen in patients with severe resting hypoxemia (oxygen saturation below 88%). The LOTT results do not change those recommendations. The difference may be because severe hypoxemia causes more biological stress through mechanisms like pulmonary vasoconstriction that occur at an oxygen threshold around 88%.
Adverse Events
The study tracked safety concerns with oxygen use:
- 23 reports of tripping over equipment (2 requiring hospitalization)
- 6 instances of fires or burns (1 requiring hospitalization)
Practical Takeaways
- COPD patients with moderate desaturation (89-93% at rest) don’t benefit from long-term oxygen
- Exercise-induced desaturation alone doesn’t justify long-term oxygen prescription
- Patients with severe hypoxemia (≤88%) should still receive oxygen therapy
- Talk to your doctor about whether oxygen therapy is appropriate for your situation
Related Studies and Research
- Oxygen multistep therapy for sudden hearing loss
- Double-blind study on physical endurance (20 males)
- Athletic performance study
- Optimal hypoxic training for VO2max: Bayesian network meta-analysis
FAQs
Does this mean all oxygen therapy for COPD is useless?
No. Patients with severe resting hypoxemia (oxygen saturation consistently below 88%) still benefit from long-term oxygen therapy based on older trials. This study only applies to patients with moderate desaturation.
What counts as moderate desaturation?
In this study, moderate resting desaturation was defined as 89-93% oxygen saturation. Moderate exercise-induced desaturation was oxygen dropping below 90% for at least 10 seconds during a 6-minute walk test.
Should I stop using oxygen if I have moderate desaturation?
Talk to your doctor before making any changes. Individual circumstances vary, and your doctor can help determine what’s right for you.
Bottom Line
The Long-Term Oxygen Treatment Trial found that supplemental oxygen provided no benefit for COPD patients with moderate resting or exercise-induced desaturation. Over 738 patients followed for up to 6 years, there was no improvement in survival, hospitalization rates, quality of life, lung function, or exercise capacity. This important finding suggests that oxygen therapy should be reserved for COPD patients with severe hypoxemia, while those with moderate desaturation may not benefit from this costly and burdensome treatment.
