Swedish Agency for Health Technology Assessment and Assessment of Social Services
Domiciliary short-term oxygen therapy
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Question
What systematic reviews have been published regarding the effects of domiciliary short-term oxygen therapy for individuals with chronic obstructive pulmonary disease, heart failure, pneumonia or pulmonary embolism?
PICO
- Population: Individuals with chronic obstructive pulmonary disease, heart failure, pneumonia or pulmonary embolism
- Intervention: Short-term oxygen therapy (up to three months) at home or in a care facility
- Comparison: No treatment, pharmacological treatment only, or other treatment
- Outcome: Oxygen saturation, dyspnea, respiratory rate, mortality, hospital admission, quality of life, side effects, and patient safety
Method
A systematic literature search was performed using the following databases: Medline (by Ovid), Scopus and Cinahl (by EBSCO).
Two authors independently assessed the abstracts of all identified studies.
Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.
Identified literature
Two relevant systematic reviews with low to moderate risk of bias were identified [1, 2]. The results and conclusions are presented in Table 1. In one relevant systematic reviews, the risk of bias was considered to be high, therefore the results and conclusions are not reported [3].
| *Number of participants is not reported. CI = confidence interval; COPD = chronic obstructive pulmonary disease; MD = mean difference; OR = odds ratio; RR = risk ratio; SMD = standardized mean difference |
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| Included studies | Population, Intervention, Control | Outcome and Results |
|---|---|---|
| Ameer et al, 2014 [1] Ambulatory oxygen for people with chronic obstructive pulmonary disease who are not hypoxaemic at rest |
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| 2 double-blind parallel RCT1 cross-over RCT1 N-of-1 double-blind RCT Setting: Australia: 2 studies Canada: 1 study New Zealand: 1 study |
Population: Adult participants (n=331) with stable COPD who had exertional dyspnoea but did not fulfil the criteria for long-term oxygen treatment; chronic hypoxaemia (resting PaO2 55-59 mmHg) without cor pulmonale (failure of right side of the heart) or PaO2 ≥60 mmHg, or developed hypoxaemia on activity (PaO2 <60 mmHg or peripheral capillary oxygen desaturation to <88% SpO2) with or without cor pulmonale with symptoms on exertion. Intervention: Ambulatory oxygen therapy more than two weeks with portable oxygen cylinders or with liquid oxygen canisters or battery-powered portable oxygen concentrators. Control: Placebo air cylinders, usual medical care or other interventions (such as counselling). |
Six-minute walking distance (2 studies, n=179) Odds ratio 1.05 (95% CI, 0.62 to 1.75) No significant difference between groups Mortality (2 studies, n=179RR 4.17 (95% CI, 0.48 to 36.3) No statistical difference between intervention and control.Moderate-quality evidence Quality of life (4 studies, n=331) Subcategory dyspnoea: MD 0.28 (95% CI, 0.10 to 0.45) Statistically significant in favour of intervention. Moderate-quality evidenceSubcategory fatigue:MD 0.14 (95% CI, 0.04 to 0.32) Statistically significant in favour of intervention. Subcategory emotional function: MD 0.10 (95% CI, –0.05 to 0.25) No significant difference between intervention and control Subcategory mastery: MD 0.13 (95% CI, –0.06 to 0.33) No significant difference between intervention and control Lung function measurements (2 studies, n=136) MD 6.52(95% CI, 5.21 to 7.83) Statistically significant in favour of intervention Adverse events (2 studies, n=83) OR: 0.77 (95% CI, 0.21 to 2.81) Non statistical difference between intervention and control. Low-quality evidence |
| Authors' conclusion: “In patients with COPD with moderate hypoxia, current evidence on ambulatory oxygen therapy reveals improvements […] in the dyspnoea and fatigue domain of quality of life. However, evidence for the clinical utility and effectiveness of ambulatory oxygen in improving mortality and exercise capacity was not evident in this review.” |
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| Ekström et al, 2016 [2] Oxygen for breathlessness in patients with chronic obstructive pulmonary disease who do not qualify for home oxygen therapy |
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| 44 RCT33 RCT included in meta-analysis Setting: Studies from different countries, not summarized by authors |
Population: Adult patients (≥18 years) with COPD (n=1195). Mild hypoxaemic and nonhypoxaemic (mean PaO2 >7.3 kPa) and did not receive long-term oxygen therapy. Intervention: Oxygen/air delivered by non-invasive method during exertion, continuously or 'as needed' over a defined period, or as short-burst oxygen before exertion. Control: Air delivered using non-invasive method at any inspired dose above that of ambient air (>21%) |
Breathlessness in daily life (not during exercise) (2 studies, 274 participants) SMD –0.13 (95% CI, –0.37 to 0.11) I2=0%; low-quality evidence Breathlessness - non-laboratory domiciliary setting during exercise (7 studies*) SMD –0.23 (95% CI –0.36 to –0.09) |
| Authors' conclusion: “Evidence for breathlessness pertains mostly to acute effects of exercise testing on breathlessness in the laboratory setting. Effects on breathlessness during daily life (not measured during an exercise test) in the domiciliary setting were smaller and were statistically non-significant.” |
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Search strategy
Medline via OvidSP 5 February 2025
| Search terms | Items found | |
|---|---|---|
| Population: | ||
| 1. | exp Pulmonary Disease, Chronic Obstructive/ | 71 544 |
| 2. | ("chronic lung disease*" or "chronic obstructive lung disease*" or "chronic bronchitis" or "pulmonary emphysema*").ab,bt,kf,ti. | 31 105 |
| 3. | exp Heart Failure/ | 158 423 |
| 4. | ((heart* or cardiac* or myocard*) adj4 (fail* or insuff* or decomp*)).ab,bt,kf,ti. | 273 753 |
| 5. | exp Pneumonia/ | 391 411 |
| 6. | (pneumon* or bronchopneumon* or pleuropneumon*).ab,bt,kf,ti. | 266 858 |
| 7. | exp Pulmonary Embolism/ | 45 179 |
| 8. | ((pulmonary or lung) adj4 (thromboembol* or embol*)).ab,bt,kf,ti. | 63 092 |
| 9. | Frail Elderly/ | 16 947 |
| 10. | (frail* adj2 (adult* or elder* or old or senior? or person? or people or patient?)).ab,bt,kf,ti. | 16 173 |
| 11. | Geriatrics/ or Health Services for the Aged/ | 49 037 |
| 12. | ((geriatric? or senior? or elderly or old*) adj2 (person? or people or adult? or patient?)).ab,bt,kf,ti. | 511 420 |
| Intervention: | ||
| 13. | Oxygen Inhalation Therapy/ | 16 585 |
| 14. | (oxygen adj4 therap*).ab,bt,kf,ti. | 20 606 |
| Study types: systematic reviews and meta-analysis | ||
| 15. | ((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/)) | 523 095 |
| Combined sets: | ||
| 16. | or/1–12 | 1 542 138 |
| 17. | 13 or 14 | 31 581 |
| 18. | 16 and 17 | 6906 |
| Final result | ||
| 19. | 18 and 15 | 253 |
| / = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase | ||
Scopus via scopus.com 5 February 2025
| TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); ALL= All fields; W/n = Within. Proximity operator retrieving terms withinn words from each other; PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second byn words; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase | ||
| Search terms | Items found | |
|---|---|---|
| Population: | ||
| 1. | TITLE-ABS-KEY ( "chronic lung disease*" OR "chronic obstructive lung disease*" OR "chronic bronchitis" OR "pulmonary emphysema*" ) | 196 927 |
| 2. | TITLE-ABS-KEY ( ( heart* OR cardiac* OR myocard* ) W/4 ( fail* OR insuff* OR decomp* ) ) | 491 109 |
| 3. | TITLE-ABS-KEY ( pneumon* OR bronchopneumon* OR pleuropneumon* ) | 603 499 |
| 4. | TITLE-ABS-KEY ( ( pulmonary OR lung ) W/4 ( thromboembol* OR embol* ) ) | 132 706 |
| 5. | TITLE-ABS-KEY ( frail* W/2 ( adult* OR elder* OR old OR senior? OR person? OR people OR patient? ) ) | 33 466 |
| 6. | TITLE-ABS-KEY ( ( geriatric? OR senior? OR elderly OR old* ) W/2 ( person? OR people OR adult? OR patient? ) ) | 548 382 |
| Intervention: | ||
| 7. | TITLE-ABS-KEY ( oxygen W/4 therap* ) | 68 555 |
| Study types: systematic reviews and meta-analysis | ||
| 8. | TITLE-ABS-KEY ( ( systematic W/2 review ) OR "meta analy*" OR metaanaly* ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”)) | |
| Combined sets: | ||
| 9. | or/1–6 | 1 848 615 |
| 10. | 9 AND 7 | 20 733 |
| Final result | ||
| 11. | 10 and 8 | 838 |
CINAHL via EBSCO 6 February 2025
| TI = Title AB = Abstract; SU = Keyword, exact or part (including all other fields for indexed and author keywords) MH = Exact subject heading, indexed keywords; TX= All text; PT = Publication type; Nn = Near. Proximity operator retrieving terms within n words from each other; * = Truncation; “ “ = Citation Marks; searches for an exact phrase | ||
| Search terms | Items found | |
|---|---|---|
| Population: | ||
| 1. | TI ("chronic lung disease*" OR "chronic obstructive lung disease*" OR "chronic bronchitis" OR "pulmonary emphysema*" ) OR AB ("chronic lung disease*" OR "chronic obstructive lung disease*" OR "chronic bronchitis" OR "pulmonary emphysema*" ) OR KW ("chronic lung disease*" OR "chronic obstructive lung disease*" OR "chronic bronchitis" OR "pulmonary emphysema*" ) | 4792 |
| 2. | MH (“Pulmonary Disease, Chronic Obstructive+” OR “Lung Disease, Obstructive+”) | 23 221 |
| 3. | TI (heart* OR cardiac* OR myocard* ) N4 ( fail* OR insuff* OR decomp* ) OR AB (heart* OR cardiac* OR myocard* ) N4 ( fail* OR insuff* OR decomp* ) OR KW (heart* OR cardiac* OR myocard* ) N4 ( fail* OR insuff* OR decomp* ) | 73 155 |
| 4. | MH “Heart Failure+” | 50 636 |
| 5. | TI ( pneumon* OR bronchopneumon* OR pleuropneumon* ) OR AB ( pneumon* OR bronchopneumon* OR pleuropneumon* ) OR KW ( pneumon* OR bronchopneumon* OR pleuropneumon* ) | 45 921 |
| 6. | MH (“Pneumonia+”) | 34 491 |
| 7. | TI (pulmonary OR lung) N4 ( thromboembol* OR embol* ) OR AB (pulmonary OR lung) N4 ( thromboembol* OR embol* ) OR KW (pulmonary OR lung) N4 ( thromboembol* OR embol* ) | 14 962 |
| 8. | MH (“Pulmonary Embolism+”) | 10 992 |
| 9. | TI (frail* N2 (adult* OR elder* OR old OR senior? OR person? OR people OR patient?) OR AB (frail* N2 (adult* OR elder* OR old OR senior? OR person? OR people OR patient? ) OR KW (frail* N2 (adult* OR elder* OR old OR senior? OR person? OR people OR patient? ) | 9631 |
| 10. | MH (“Frail Elderly+”) | 9093 |
| 11. | TI (geriatric? OR senior? OR elderly OR old*) N2 (person? OR people OR adult? OR patient?) OR AB (geriatric? OR senior? OR elderly OR old*) N2 (person? OR people OR adult? OR patient?) OR KW (geriatric? OR senior? OR elderly OR old*) N2 (person? OR people OR adult? OR patient?) | 205 152 |
| 12. | MH (“Health Services for Older Persons+” OR “Geriatrics+”) | 13 428 |
| Intervention: | ||
| 13. | MH “oxygen therapy+” | 10 349 |
| 14. | TI (oxygen N4 therap*) OR AB( oxygen N4 therap*) OR KW(oxygen N4 therap*) | 5210 |
| Study types: systematic reviews and meta-analysis | ||
| 15. | ((TI((systematic N3 review) OR "meta analys*" OR metaanalys*) OR AB((systematic N3 review) OR "meta analys*" OR metaanalys*) OR SU((systematic N3 review) OR "meta analys*" OR metaanalys*)) OR (PT "Systematic Review" OR PT "meta analysis")) NOT (MH "Case Studies" OR PT "Commentary" OR PT "Editorial" OR PT "Letter") | 275 634 |
| Combined sets: | ||
| 16. | or/1-12 | 399 051 |
| 17. | 13 OR 14 | 12 361 |
| 18. | 16 AND 17 | 2093 |
| Final result | ||
| 19. | 18 AND 15 | 106 |
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