Correspondence
When should we treat
moderate hypoxaemia
in patients with COPD?
Authors’ reply
It is correct to point out that the
six randomised controlled trials
that were included in our meta-
analysis 1 had somewhat different
inclusion criteria. However, these
criteria correspond to patterns of
hypoxaemia that overlap to a very
large extent. Daytime partial pressure
of oxygen in arterial blood in the
range of 56–65 mm Hg approximates
pulse oximetry saturation (SpO 2)
between 89% and 93%. Moderate
daytime hypoxaemia and exercise-
induced desaturation are predictors
of nocturnal desaturation. 2,3 We
had also observed that patients
who participated in the Long-
Term Oxygen Treatment Trial 4 and
those with nocturnal desaturation
who engaged in the International
Nocturnal Oxygen trial 5 had very
similar baseline characteristics,
including age, lung function,
daytime SpO 2 at rest, and quality-
of-life scores, and had similar 3-year
mortality rates. These observations
led us to pool the six trials in our
analysis. Although prescribed periods
of oxygen supplementation were
also different, mean daily exposure
to oxygen did not exceed 15 h/day
in any trial and higher daily exposure
was not associated with better
outcome.
Because of the inconvenience and
cost of long-term oxygen therapy
(LTOT), mortality has been considered
as the primary outcome in the
foundational trials of LTOT in chronic
obstructive pulmonary disease6,7 and
in the three largest trials that were
included in our meta-analysis.4,5,8 Of
course, other important outcomes exist,
such as exacerbation, hospitalisation
rates, and quality of life. We found
that supplemental oxygen in patients
with moderate hypoxaemia most
probably has little or no effect on these
www.thelancet.com/respiratory Vol 10 November 2022
outcomes.1 The benefits of oxygen on
cognitive and muscular dysfunction
and on prevention of heart disease
have not been well studied. Markers of
toxicity from hypoxaemia would only
represent intermediate outcomes in
long-term clinical trials that are costly
and difficult to conduct. However,
such biomarkers could identify
patients who have not adapted well to
chronic hypoxaemia, predict response If you would like to respond to
to therapy, and help decide whether an article published in
home oxygen is truly indicated. This The Lancet Respiratory Medicine,
please submit your
approach would facilitate precision correspondence online at:
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Author declarations remain the same as in the com/THELANCETRM
original Article.
*Yves Lacasse, Richard Casaburi,
François Maltais
yves.lacasse@med.ulaval.ca
Centre de recherche, Centre de pneumologie,
Institut universitaire de cardiologie et de
pneumologie de Québec-Université Laval, Quebec
City, QC G1V 4G5, Canada (YL, FM); Rehabilitation
Clinical Trials Center, Lundquist Institute for
Biomedical Innovation at Harbor-UCLA Medical
Center, Torrance, CA, USA (RC)
1 Lacasse Y, Casaburi R, Sliwinski P, et al.
Home oxygen for moderate hypoxaemia in
chronic obstructive pulmonary disease:
a systematic review and meta-analysis.
Lancet Respir Med 2022; 10: 1029–37.
2 Little SA, Elkholy MM, Chalmers GW, Farouk A,
Patel KR, Thomson NC. Predictors of nocturnal
oxygen desaturation in patients with COPD.
Respir Med 1999; 93: 202–07.
3 Scott AS, Baltzman MA, Chan R, Wolkove N.
Oxygen desaturation during a 6 min walk test
is a sign of nocturnal hypoxemia. Can Respir J
2011; 18: 333–37.
4 Long-Term Oxygen Treatment Trial Research
Group, Albert RK, Au DH, et al. A randomized
trial of long-term oxygen for COPD with
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5 Lacasse Y, Sériès F, Corbeil F, et al. Randomized
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pulmonary disease. N Engl J Med 2020;
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6 Medical Research Council Working Party.
Long term domiciliary oxygen therapy in
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1981; 1: 681–86.
7 Nocturnal Oxygen Therapy Trial Group.
Continuous or nocturnal oxygen therapy in
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