HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Permissions Request Permissions Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lacasse, Y. Articles by Maltais, F. Search for Related Content PubMed Articles by Lacasse, Y. Articles by Maltais, F.

From the authors

Centre de recherche, Hôpital Laval, Institut universitaire de cardiologie et de pneumologie de l'Université Laval, Québec, Canada

We would like to thank T.L. Petty for his interesting comments regarding our trial of ambulatory oxygen (AO) in chronic obstructive pulmonary disease (COPD) 1. The question raised by T.L. Petty was the following: when is the best time to initiate AO in oxygen-dependent COPD? He suggested AO should be provided as early as possible after the introduction of long-term oxygen therapy (LTOT) to avoid rapid adjustment to the limitations imposed by the stationary oxygen delivery system.

Unfortunately, inappropriate prescription of LTOT is not unusual 2. Our trial strictly targeted oxygen-dependent patients. Thus, to be included, patients had to be on LTOT for 3 months. This was to avoid the inclusion of patients who were prescribed oxygen following an acute exacerbation of the disease and who may not fulfil LTOT criteria upon re-evaluation. Therefore, at study entry, our patients were not oxygen naive.

The problem is that oxygen dependence cannot be easily confirmed in oxygen-naive patients. In our experience, acute exacerbation precedes the prescription of LTOT in most patients, i.e. during a period of clinical instability. In addition, 30% of patients meeting criteria for domiciliary oxygen after 1 month of apparent stability no longer met the same criteria after an additional 3 months of observation 3. Whether provision of AO to oxygen-dependent patients would have an effect on quality of life if it was introduced earlier would pose important, methodological problems to clinical trials.

In conclusion, we would rather ask the following question: what is the best way of initiating ambulatory oxygen in oxygen-dependent chronic obstructive pulmonary disease? In this regard, we agree with T.L. Petty that it would be of interest to evaluate whether pulmonary rehabilitation in conjunction with ambulatory oxygen could facilitate compliance and further improve quality of life.

REFERENCES

1. Lacasse Y, Lecours R, Pelletier C, Bégin R, Maltais F. Randomised trial of ambulatory oxygen in oxygen-dependent COPD. Eur Respir J 2005;25:1032–1038.[Abstract/Free Full Text]
2. Guyatt GH, McKim DA, Austin P, et al. Appropriateness of domiciliary oxygen delivery. Chest 2000;118:1303–1308.[Abstract/Free Full Text]
3. Levi-Valensi P, Weitzenblum E, Pedinielli JL, Racineux JL, Duwoos H. Three-month follow-up of arterial blood gas determinations in candidates for long-term oxygen therapy: a multicentric study. Am Rev Respir Dis 1986;133:547–551.[Medline] [Order article via Infotrieve]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Permissions Request Permissions Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lacasse, Y. Articles by Maltais, F. Search for Related Content PubMed Articles by Lacasse, Y. Articles by Maltais, F.