Oxygen therapy is the mainstay treatment for people in the late stages of a lung-destroying disease that kills thousands — but could it extend their lives longer if they started it sooner?
Almost 30 years after oxygen’s benefit emerged, the U.S. government is beginning a major study to finally find that out.
It’s a critical issue, as the lung killer called COPD, or chronic obstructive pulmonary disease, is on the rise — and no other treatment so far has been proven to help postpone death the way oxygen therapy has, at least in severely ill patients.
“The real question is when to start” oxygen, says Dr. Tom Croxton of the National Institutes of Health, who oversees the new research.
“It’s hard for me to argue that it’s opportune” timing to find the answer, he adds, “when in fact it may be very past due for this question.”
The research is part of a growing national effort to get more of the estimated 24 million Americans with the breath-robbing disease diagnosed and properly treated.
COPD is the killer with an identity crisis. Half of those affected do not even know they have it. Aside from the eye-glazing name — a term for diseases once called emphysema and chronic bronchitis — it is easy to shrug off the main symptom, shortness of breath, as a sign of aging or poor fitness.
Only half get recommended care
And even the diagnosed get only about half the recommended care, such as medications that can significantly improve the quality of their day-to-day lives, says a RAND study in the December issue of the journal Chest.
Such dismal numbers don’t surprise specialists.
Adds Dr. Robert A. Wise of Johns Hopkins University: “We may not be able to get them to 100 percent, but we can almost always get them to be able to be a lot more self-sufficient, and that’s what a lot of patients with COPD are concerned about. It’s not just the shortness of breath; it’s the loss of independence.”
Healthy lungs inflate and deflate like balloons as they take in oxygen and remove carbon dioxide. With COPD, lungs become scarred and lose their elasticity. They can’t deflate fully. Patients need ever-deeper breaths to get air into the remaining healthy portion, even as trapped stale air enlarges the lungs until deep breaths become physically impossible.
Smoking is the main cause, but about one in six patients has never smoked. Certain pollutants and genetic factors also play a role. Doctors urge a simple lung test for anyone at risk: smokers and ex-smokers in their 40s, and anyone with shortness of breath, an unexplained prolonged cough or increased phlegm.
When to start treatment?
There is no cure. But, inhaled medications do minimize symptoms. Pulmonary rehabilitation is key, too, in helping preserve remaining lung capacity. Patients learn to breathe like athletes so they get the most air from damaged lungs, and special exercises to strengthen muscles that help lung performance. Also, lung surgery helps a subset of patients.
The big quandary is who needs oxygen therapy, too, and when.
Studies in the late 1970s showed that breathing supplemental oxygen, for up to 18 hours a day, helped patients with severe COPD live longer than those not treated. Consequently, Medicare pays for oxygen when patients get ill enough. The main requirement is that their blood’s “oxygen saturation” be around 88 percent or worse; in healthy people, oxygen saturation doesn’t dip below 96 percent.
What about patients with mid-stage COPD? Enter the NIH’s $28 million (euro21 million) study. Next summer, scientists at 14 hospitals around the United States hope to begin enrolling 3,500 such patients, to test oxygen’s effects on both life expectancy and quality of life.
