Long-term oxygen therapy for severe COPD final report
Address any addition specific assessment questions formulated by the project team in consultation with AHRQ.
| Main Authors: | , , , |
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| Corporate Authors: | , , |
| Format: | eBook |
| Language: | English |
| Published: |
Rockville, Maryland
Agency for Healthcare Research and Quality
2004, June 11, 2004
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| Series: | Technology assessment
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| Subjects: | |
| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | Address any addition specific assessment questions formulated by the project team in consultation with AHRQ. Oxygen is an essential component of oxidative metabolism and is used as a treatment in patients with chronic lung disease. Chronic obstructive lung disease (COPD) is the most common chronic lung disease in the US and is the most common indication for supplemental oxygen. Criteria have been developed to help identify patients with COPD who may benefit from long-term oxygen therapy (LTOT). These criteria are based on the known detrimental pathophysiological effects of chronic hypoxemia. The hemoglobin molecule carries the majority of oxygen in the blood and is exquisitely designed to remain more than 90% saturated with oxygen provided the partial pressure of oxygen (PaO2) in arterial blood is close to or above 55 to 60 mm Hg. Once the PaO2 in arterial blood starts to fall below the 55 to 60 mm Hg threshold there is a steep reduction in the saturation of the hemoglobin molecule. Hemoglobin saturations of less than 90% are thought to result in a significant reduction in tissue oxygen delivery. By increasing the concentration of oxygen in inhaled air, supplemental oxygen improves both the PaO2 of oxygen dissolved in arterial blood and the degree of oxygen saturation of the hemoglobin molecule (SaO2). These effects in turn improve the oxygen delivery to organs and tissues allowing oxidative metabolism to continue in the setting of chronic lung disease. The criteria based on these physiological observations have been developed in an attempt to identify patients who may benefit from supplemental oxygen by preventing deaths due to chronic hypoxemia and heart disease related to cor pulmonale. It is generally accepted that COPD patients with PaO2 d 55 mmHg, or those with PaO2 of 56 to 59 mmHg with evidence of end organ disease (e.g., pulmonary hypertension, cor pulmonale, polycythemia (hematocrit > 55%), arrhythmias, congestive heart failure, or impaired mental status) benefit from supplemental oxygen. The cost to the health care system of providing supplemental oxygen to patients with COPD for up to 24 hours per day for many years is substantial. These costs include the cost of oxygen itself, the oxygen delivery systems to allow the patients to use the oxygen during activities of daily living or at night, and the many private vendors who service the equipment and monitor the patients. CMS has developed a national coverage policy in 1985 based on discussions with experts and clinical evidence. CMS presently requested a technology assessment from AHRQ to summarize the available clinical and scientific evidence on the appropriateness and effective use of LTOT in patients with COPD. This summary will be presented as background for discussion to an expert working group convened by NHLBI to discuss LTOT. In particular, CMS would like the report to address the following issues: 1. Identify and analyze studies of long-term oxygen use that may have substantial impact on public health or health care costs.2. Identify and analyze studies that examine the efficacy or effectiveness of long-term oxygen on specific indications, in particular COPD.3. Identify and analyze studies to determine if long-term oxygen therapy is beneficial, and if there are any adverse effects to long-term oxygen therapy.4. Identify and analyze studies that examine the impact of long-term oxygen therapy on the progression of COPD.5. |
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| Item Description: | Title from PDF cover. - Subtitle from caption. - "This report is based on research conducted by the Tufts-New England Medical Center Evidence-based Practice Center (EPC) under contract to the Agency for Health care Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0022)"--PDF p. 2 |
| Physical Description: | 1 PDF file (41, 14 pages) |