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Sammanställning av systematiska översikter från SBU:s upplysningstjänst
Vilken sammanställd forskning finns om effekter av kortvarig syrgasbehandling i hemmet för personer med kroniskt obstruktiv lungsjukdom (KOL), hjärtsvikt, lunginflammation eller lungemboli?
Frågeställare: Läkemedelsstrateg, Region Jönköpings län
Det finns ett fåtal sammanställda studier som undersökt kortvarig syrgasbehandling i hemmet för personer med ingen till måttlig hypoxi, men effekten av interventionen på andfåddhet är oklar.
Det saknas välgjorda systematiska översikter som utvärderar effekten av kortvarig syrgasbehandling i hemmet på andra patientgrupper såsom personer med hjärtsvikt, lunginflammation eller lungemboli. Det saknas välgjorda systematiska översikter som studerat kortvarig syrgasbehandling i hemmet efter sjukhusvistelse på grund av andra tillstånd än KOL.
Att resultat saknas eller har mycket låg tillförlitlighet ska inte tolkas som att insatserna saknar effekt. Det betyder att det behövs forskning för att förbättra kunskapsläget.
Se även avsnittet SBU:s kommentarer.
Upplysningstjänsten har tillsammans med frågeställaren formulerat frågan enligt följande PICO1:
Vi inkluderar systematiska översikter publicerade i vetenskapliga tidskrifter samt systematiska översikter från myndigheter och HTA-organisationer, som har publicerats på engelska eller ett av de skandinaviska språken.
1. PICO är en förkortning för patient/population/problem, intervention (insats, behandling)/, comparison/control (jämförelseintervention (insats, behandling)) och outcome (utfallsmått).
Vi inkluderade två systematiska översikter med måttlig risk för bias [4, 5]. Det innebär att vi anser att de är tillräckligt välgjorda för att presentera resultaten. De två inkluderade systematiska översikterna hade inte som uttalad målsättning att sammanställa studier med kortvarig syrgasbehandling, men i översikterna sammanställdes studier med behandlingstid som motsvarar kortvarig syrgasbehandling (upp till tre månader), därför anser SBU att översikterna är relevanta för rapportens frågeställning.
Sökning och urval av studier, samt bedömning av risk för bias beskrivs i metodavsnittet. Resultaten har inte analyserats utifrån svenska förhållanden.
Ameer och medförfattare publicerade år 2014 en systematisk översikt över effekten av mobil syrgasbehandling vid träning eller i hemmiljö hos personer med KOL med mild eller måttlig hypoxi [4]. Totalt ingick fyra studier (RCT- och cross-over-studier) från åren 1995 till 2011 i översikten och interventionen jämfördes med kontroll, vilket innebar behandling med placebo (vanlig luft), sedvanlig vård eller andra interventioner (till exempel psykosocialt stöd och rådgivning). Översikten bedöms av SBU ha måttlig risk för bias, bland annat på grund av brister i sökstrategin.
Ameer och medförfattare fann ingen effekt av syrgasbehandling på prestation i ett gångtest (engelska: six minute walking distance), som mäter hur långt personen kan gå under 6 minuter. Det var heller ingen signifikant skillnad i mortalitet mellan behandlingsgrupp och kontrollgrupp. Däremot fann översiktsförfattarna en signifikant effekt av syrgasbehandling på lungans syreupptagning som mättes genom perifer syremättnad. I översikten analyserades också fyra delskalor av ett livskvalitetsformulär (engelska: chronic respiratory questionnaire) som mäter livskvalitet vid långvarig lungsjukdom. Personer i behandlingsgruppen rapporterade i genomsnitt bättre livskvalitet, i delskalorna som skattade andfåddhet och trötthet, jämfört med kontrollgruppen. Översiktsförfattarna fann ingen statistisk signifikant effekt av syrgasbehandling på delskalorna för livskvalitet relaterat till emotionell funktion och upplevd kontroll. Översiktsförfattarna bedömde att studierna som ingick i översikten över lag hade en måttlig risk för bias eftersom det saknades tillräckliga redogörelser för studiernas metod samt att majoriteten av studierna saknade preregistrerat protokoll.
Eftersom resultaten baserades enbart på fyra inkluderade studier, och de resultat som redovisades inte var konsistenta vad gäller statistiskt signifikanta effekter, ansåg översiktsförfattarna att det inte gick att dra några generella slutsatser om effekten av mobil syrgasbehandling för personer med KOL med mild eller måttlig hypoxi.
Ekström och medförfattare publicerade år 2016 en systematisk översikt över effekten av syrgasbehandling vid träning eller i daglig livsföring i hemmet för personer med KOL med ingen eller mild hypoxi [5]. Samtliga studier var randomiserade kontrollerade studier och syrgasbehandling jämfördes med placebo (vanlig luft).
Majoriteten av studierna i översikten utfördes i laboratoriemiljö och är därför inte relevanta för SBU:s sammanställning. Två analyser bedömdes vara relevanta för SBU:s frågeställning (Tabell 1). Ekström och medförfattare fann ingen statistiskt signifikant effekt av syrgasbehandling på andfåddhet i det dagliga livet jämfört med placebo. I den systematiska översikten sammanställdes också studier som undersökt andfåddhet vid ansträngning med syrgasbehandling i hemmiljö. Syrgasbehandling uppvisade i analysen liten och statistisk säkerställd effekt på andfåddhet vid ansträngning.
Vi identifierade också en översikt som var relevant för frågan men som vi bedömde ha hög risk för bias [6]. Eftersom hög risk för bias innebär en betydande risk för att resultaten är missvisande presenterar vi inga resultat eller slutsatser från den översikten.
| *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 |
||
| Included studies | Population, Intervention, Control | Outcome and Results |
|---|---|---|
| Ameer et al, 2014 [4] Ambulatory oxygen for people with chronic obstructive pulmonary disease who are not hypoxaemic at rest |
||
| 2 double-blind parallel RCT 1 cross-over RCT 1 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=179) RR 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 evidence Subcategory 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.” |
||
| Ekström et al, 2016 [5] Oxygen for breathlessness in patients with chronic obstructive pulmonary disease who do not qualify for home oxygen therapy |
||
| 44 RCT 33 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 longterm 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.” |
||
Vi identifierade även riktlinjer från andningssviktregistret Swedevox publicerade i februari år 2025. I riktlinjerna avhandlas bland annat korttidsbehandling med hemsyrgas vid utskrivning från sjukhus [7].
Upplysningstjänsten gör en systematisk sökning i minst två vetenskapliga databaser. Fullständig sökdokumentation finns i Bilaga 1.
Bedömning av vilka artiklar som är relevanta sker i två steg och utgår från frågeställningen.
Skillnader i bedömningarna löses genom diskussion.
Flödesschema för urval av artiklar finns i Bilaga 2. Exkluderade artiklar finns i Bilaga 3.
Risk för bias i relevanta systematiska översikter bedöms av två utredare, oberoende av varandra. Skillnader i bedömningarna löses genom diskussion.
Vid bedömning används granskningsmallen SnabbSTAR. SnabbSTAR har fem steg, där översikter som uppfyller de krav som ställs i steg 1–4 bedöms ha måttlig risk för bias, och om 1-5 är uppfyllda bedöms risken för bias vara låg.
En översikt som har brister i stegen 1–4 bedöms ha hög risk för bias och redovisas inte eftersom resultaten kan vara missvisande.
SBU:s bedömning av risk för bias finns redovisad i Bilaga 4. Granskningsmallen SnabbSTAR finns i Bilaga 5.
Detta svar är sammanställt av Jens Fust (utredare), Marie Nilsson (utredare), Sara Fundell (projektadministratör), Emma Wojda (produktsamordnare), Per Lytsy (intern sakkunnig) samt Pernilla Östlund (avdelningschef) vid SBU.
| 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 | ||
| 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 |
| 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 |
| Excluded articles | Reason for exclusion |
|---|---|
| Systematic reviews | |
| Ambrosino N, Fracchia C. Strategies to relieve dyspnoea in patients with advanced chronic respiratory diseases. A narrative review. Pulmonology. 2019;25(5):289-98. Available from: https://doi.org/10.1016/j.pulmoe.2019.04.002 | Not a systematic review |
| Aranburu-Imatz A, Lopez-Carrasco JC, Moreno-Luque A, Jimenez-Pastor JM, Valverde-Leon MDR, Rodriguez-Cortes FJ, et al. Nurse-Led Interventions in Chronic Obstructive Pulmonary Disease Patients: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022;19(15). Available from: https://doi.org/10.3390/ijerph19159101 | Relevant results not analysed separately |
| Asano R, Mathai SC, Macdonald PS, Newton PJ, Currow DC, Phillips J, et al. Oxygen use in chronic heart failure to relieve breathlessness: A systematic review. Heart Fail Rev. 2020;25(2):195-205. Available from: https://doi.org/10.1007/s10741-019-09814-0 | Wrong intervention |
| Austin M, Wood-Baker R. Oxygen therapy in the pre-hospital setting for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006(3):CD005534. Available from: https://doi.org/10.1002/14651858.CD005534.pub2 | Wrong intervention |
| Bolton CE, Bevan-Smith EF, Blakey JD, Crowe P, Elkin SL, Garrod R, et al. British Thoracic Society guideline on pulmonary rehabilitation in adults. Thorax. 2013;68 Suppl 2:ii1-30. Available from: https://doi.org/10.1136/thoraxjnl-2013-203808 | Not a systematic review |
| Bondarenko J, Dal Corso S, Dillon MP, Singh S, Miller BR, Kein C, et al. Clinically important changes and adverse events with centre-based or home-based pulmonary rehabilitation in chronic respiratory disease: A systematic review and meta-analysis. Chron Respir Dis. 2024;21:14799731241277808. Available from: https://doi.org/10.1177/14799731241277808 | Wrong intervention |
| Bradley JM, Lasserson T, Elborn S, Macmahon J, O'Neill B. A systematic review of randomized controlled trials examining the short-term benefit of ambulatory oxygen in COPD. Chest. 2007;131(1):278-85. Available from: https://doi.org/10.1378/chest.06-0180 | Wrong intervention |
| Bradley JM, O'Neill B. Short-term ambulatory oxygen for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2005;2005(4):CD004356. Available from: https://doi.org/10.1002/14651858.CD004356.pub3 | Wrong intervention |
| Bruni A, Garofalo E, Cammarota G, Murabito P, Astuto M, Navalesi P, et al. High Flow Through Nasal Cannula in Stable and Exacerbated Chronic Obstructive Pulmonary Disease Patients. Rev Recent Clin Trials. 2019;14(4):247-60. Available from: https://doi.org/10.2174/1574887114666190710180540 | Wrong intervention |
| Chandy GP, Aaron SD. Treatment of chronic obstructive pulmonary disease in older adults. Geriatr Aging. 2004;7(8). | Not a systematic review |
| Corlateanu A, Montanari G, G. Mathioudakis A, Botnaru V, Siafakas N. Management of Stable COPD: An Update. Curr Respir Med Rev. 2014;9(6):352-9. Available from: https://doi.org/10.2174/1573398x10666140222001646 | Not a systematic review |
| Cranston JM, Crockett A, Currow D, Ekstrom M. WITHDRAWN: Oxygen therapy for dyspnoea in adults. Cochrane Database Syst Rev. 2013;2013(11):CD004769. Available from: https://doi.org/10.1002/14651858.CD004769.pub3 | Wrong population |
| Cranston JM, Crockett AJ, Moss JR, Alpers JH. Domiciliary oxygen for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2005;2005(4):CD001744. Available from: https://doi.org/10.1002/14651858.CD001744.pub2 | Wrong intervention |
| Dretzke J, Wang J, Yao M, Guan N, Ling M, Zhang E, et al. Home Non-Invasive Ventilation in COPD: A Global Systematic Review. Chronic Obstr Pulm Dis. 2022;9(2):237-51. Available from: https://doi.org/10.15326/jcopdf.2021.0242 | Wrong intervention |
| Du Y, Zhang H, Ma Z, Liu J, Wang Z, Lin M, et al. High-Flow Nasal Oxygen versus Noninvasive Ventilation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients: A Meta-Analysis of Randomized Controlled Trials. Can Respir J. 2023;2023:7707010. Available from: https://doi.org/10.1155/2023/7707010 | Wrong intervention |
| Duan L, Xie C, Zhao N. Effect of high-flow nasal cannula oxygen therapy in patients with chronic obstructive pulmonary disease: A meta-analysis. J Clin Nurs. 2022;31(1-2):87-98. Available from: https://doi.org/10.1111/jocn.15957 | Wrong intervention |
| Elshof J, Duiverman ML. Clinical Evidence of Nasal High-Flow Therapy in Chronic Obstructive Pulmonary Disease Patients. Respiration. 2020;99(2):140-53. Available from: https://doi.org/10.1159/000505583 | Wrong intervention |
| Esperanza QP. Importance of medical oxygen in multiple therapeutic uses. European Journal of Clinical Pharmacy. 2017;19(2). | No synthesis |
| Fu C, Liu X, Zhu Q, Wu X, Hao S, Xie L, et al. Efficiency of High-Flow Nasal Cannula on Pulmonary Rehabilitation in COPD Patients: A Meta-Analysis. BioMed Research International. 2020;2020. Available from: https://doi.org/10.1155/2020/7097243 | Wrong intervention |
| Fu Y, Chapman EJ, Boland AC, Bennett MI. Evidence-based management approaches for patients with severe chronic obstructive pulmonary disease (COPD): A practice review. Palliat Med. 2022;36(5):770-82. Available from: https://doi.org/10.1177/02692163221079697 | Not a systematic review |
| Giacomini M, DeJean D, Simeonov D, Smith A. Experiences of living and dying with COPD: a systematic review and synthesis of the qualitative empirical literature. Ont Health Technol Assess Ser. 2012;12(13):1-47. | Wrong intervention |
| Gloeckl R, Osadnik C, Bies L, Leitl D, Koczulla AR, Kenn K. Comparison of continuous flow versus demand oxygen delivery systems in patients with COPD: A systematic review and meta-analysis. Respirology. 2019;24(4):329-37. Available from: https://doi.org/10.1111/resp.13457 | Wrong intervention |
| Hancox RJ, Jones S, Baggott C, Chen D, Corna N, Davies C, et al. New Zealand COPD Guidelines: Quick Reference Guide. N Z Med J. 2021;134(1530):76-110. | Not a systematic review |
| Hasegawa T, Ochi T, Goya S, Matsuda Y, Kako J, Watanabe H, et al. Efficacy of supplemental oxygen for dyspnea relief in patients with advanced progressive illness: A systematic review and meta-analysis. Respir Investig. 2023;61(4):418-37. Available from: https://doi.org/10.1016/j.resinv.2023.03.005 | Relevant results not analysed separately |
| Holte TO, Asmervik J, Bakke P, Stavem K. Effect of Intermittent Oxygen Therapy Among COPD Patients without Severe Hypoxemia. 2008. | Not a systematic review |
| Huang X, Du Y, Ma Z, Zhang H, Jun L, Wang Z, et al. High-flow nasal cannula oxygen versus conventional oxygen for hypercapnic chronic obstructive pulmonary disease: A meta-analysis of randomized controlled trials. Clin Respir J. 2021;15(4):437-44. Available from: https://doi.org/10.1111/crj.13317 | Wrong intervention |
| Jacobs SS, Krishnan JA, Lederer DJ, Ghazipura M, Hossain T, Tan AM, et al. Home Oxygen Therapy for Adults with Chronic Lung Disease. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2020;202(10):e121-e41. Available from: https://doi.org/10.1164/rccm.202009-3608ST | Wrong intervention |
| Jacome C, Jacome M, Correia S, Flores I, Farinha P, Duarte M, et al. Effectiveness, Adherence and Safety of Home High Flow Nasal Cannula in Chronic Respiratory Disease and Respiratory Insufficiency: A Systematic Review. Arch Bronconeumol. 2024;60(8):490-502. Available from: https://doi.org/10.1016/j.arbres.2024.05.001 | Wrong intervention |
| Kerstjens HA. Stable chronic obstructive pulmonary disease. BMJ. 1999;319(7208):495-500. Available from: https://doi.org/10.1136/bmj.319.7208.495 | Not a systematic review |
| Khor YH, Ekstrom M. The benefits and drawbacks of home oxygen therapy for COPD: what's next? Expert Rev Respir Med. 2024;18(7):469-83. Available from: https://doi.org/10.1080/17476348.2024.2379459 | Not a systematic review |
| Ko FW, Chan KP, Hui DS, Goddard JR, Shaw JG, Reid DW, et al. Acute exacerbation of COPD. Respirology. 2016;21(7):1152-65. Available from: https://doi.org/10.1111/resp.12780 | Not a systematic review |
| Koo K, Kwong J, Nguyen J, Jon F, Zeng L, Dennis K, et al. A review of the impact of oxygen therapy in patients with advanced lung disease. J Pain Manag. 2012;5(2). | Wrong population |
| Kopsaftis Z, Carson-Chahhoud KV, Austin MA, Wood-Baker R. Oxygen therapy in the pre-hospital setting for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2020;1(1):CD005534. Available from: https://doi.org/10.1002/14651858.CD005534.pub3 | Wrong intervention |
| Kunisaki KM, Rice KL, Niewoehner DE. Management of acute exacerbations of chronic obstructive pulmonary disease in the elderly : an appraisal of published evidence. Drugs Aging. 2007;24(4):303-24. Available from: https://doi.org/10.2165/00002512-200724040-00004 | Not a systematic review |
| Lacasse Y, Casaburi R, Sliwinski P, Chaouat A, Fletcher E, Haidl P, et al. Home oxygen for moderate hypoxaemia in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Lancet Respir Med. 2022;10(11):1029-37. Available from: https://doi.org/10.1016/S2213-2600(22)00179-5 | Wrong intervention |
| Lassen ML, Risgaard B, Baekgaard JS, Rasmussen LS. Determining a safe upper limit of oxygen supplementation for adult patients: a systematic review. BMJ Open. 2021;11(7):e045057. Available from: https://doi.org/10.1136/bmjopen-2020-045057 | Wrong population |
| Lee H, Kim J, Tagmazyan K. Treatment of stable chronic obstructive pulmonary disease: the GOLD guidelines. Am Fam Physician. 2013;88(10):655-63, 63B-F. | Not a systematic review |
| Liu W, Zhu M, Xia L, Yang X, Huang P, Sun Y, et al. Transnasal High-Flow Oxygen Therapy versus Noninvasive Positive Pressure Ventilation in the Treatment of COPD with Type II Respiratory Failure: A Meta-Analysis. Comput Math Methods Med. 2022;2022:3835545. Available from: https://doi.org/10.1155/2022/3835545 | Not a systematic review |
| Liu Y, Gong F. Determination of whether supplemental oxygen therapy is beneficial during exercise training in patients with COPD: A systematic review and meta-analysis. Exp Ther Med. 2019;18(5):4081-9. Available from: https://doi.org/10.3892/etm.2019.8026 | Wrong intervention |
| Maitra S, Bhattacharjee S, Som A. Noninvasive Ventilation and Oxygen Therapy after Extubation in Patients with Acute Respiratory Failure: A Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med. 2019;23(9):414-22. Available from: https://doi.org/10.5005/jp-journals-10071-23236 | Wrong population |
| Mal S, McLeod S, Iansavichene A, Dukelow A, Lewell M. Effect of out-of-hospital noninvasive positive-pressure support ventilation in adult patients with severe respiratory distress: a systematic review and meta-analysis. Ann Emerg Med. 2014;63(5):600-7 e1. Available from: https://doi.org/10.1016/j.annemergmed.2013.11.013 | Wrong intervention |
| Marciniuk DD, Goodridge D, Hernandez P, Rocker G, Balter M, Bailey P, et al. Managing dyspnea in patients with advanced chronic obstructive pulmonary disease: a Canadian Thoracic Society clinical practice guideline. Can Respir J. 2011;18(2):69-78. Available from: https://doi.org/10.1155/2011/745047 | Wrong intervention |
| Marjanovic N, Couvreur R, Lamarre J, Piton M, Guenezan J, Mimoz O. High-flow nasal cannula oxygen therapy versus noninvasive ventilation in acute respiratory failure related to suspected or confirmed acute heart failure: a systematic review with meta-analysis. Eur J Emerg Med. 2024;31(6):388-97. Available from: https://doi.org/10.1097/MEJ.0000000000001171 | Wrong intervention |
| McCrory DC, Brown C, Gelfand SE, Bach PB. Management of acute exacerbations of COPD: a summary and appraisal of published evidence. Chest. 2001;119(4):1190-209. Available from: https://doi.org/10.1378/chest.119.4.1190 | Wrong intervention |
| McCurdy BR. Hospital-at-home programs for patients with acute exacerbations of chronic obstructive pulmonary disease (COPD): an evidence-based analysis. Ont Health Technol Assess Ser. 2012;12(10):1-65. | Not a systematic review |
| Meduri GU. Noninvasive positive-pressure ventilation in patients with acute respiratory failure. Clin Chest Med. 1996;17(3):513-53. Available from: https://doi.org/10.1016/s0272-5231(05)70330-0 | Not a systematic review |
| Mohammed J, Da Silva H, Van Oosterwijck J, Calders P. Effect of respiratory rehabilitation techniques on the autonomic function in patients with chronic obstructive pulmonary disease: A systematic review. Chron Respir Dis. 2017;14(3):217-30. Available from: https://doi.org/10.1177/1479972316680844 | Wrong intervention |
| Moya-Gallardo E, Fajardo-Gutierrez J, Acevedo K, Verdugo-Paiva F, Bravo-Jeria R, Ortiz-Munoz L, et al. High-flow nasal cannula in adults with chronic respiratory diseases during physical exercise: a systematic review and meta-analysis. BMJ Open Respir Res. 2024;11(1). Available from: https://doi.org/10.1136/bmjresp-2024-002431 | Wrong population |
| Nonoyama ML, Brooks D, Lacasse Y, Guyatt GH, Goldstein RS. Oxygen therapy during exercise training in chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2007;2007(2):CD005372. Available from: https://doi.org/10.1002/14651858.CD005372.pub2 | Wrong intervention |
| O'Neill B, Mahon JM, Bradley J. Short-burst oxygen therapy in chronic obstructive pulmonary disease. Respir Med. 2006;100(7):1129-38. Available from: https://doi.org/10.1016/j.rmed.2006.03.038 | Wrong intervention |
| Oltra G, Ricciardelli M, Virgilio S, Fernandez Parmo D, Ruiz A, Liquitay CME, et al. High-flow nasal cannula during pulmonary rehabilitation for people with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Physiother Res Int. 2024;29(2):e2088. Available from: https://doi.org/10.1002/pri.2088 | Wrong intervention |
| Park YB, Rhee CK, Yoon HK, Oh YM, Lim SY, Lee JH, et al. Revised (2018) COPD Clinical Practice Guideline of the Korean Academy of Tuberculosis and Respiratory Disease: A Summary. Tuberc Respir Dis (Seoul). 2018;81(4):261-73. Available from: https://doi.org/10.4046/trd.2018.0029 | Not a systematic review |
| Pearson M. Chronic Obstructive Pulmonary Disease: National clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax. 2004;59. | Not a systematic review |
| Perry E, Williams B. The quandary of prehospital oxygen administration in chronic obstructive pulmonary disease -- a review of the literature. Journal of Emergency Primary Health Care. 2008;6(1). | Wrong intervention |
| Piraino T. Noninvasive Respiratory Support in Acute Hypoxemic Respiratory Failure. Respir Care. 2019;64(6):638-46. Available from: https://doi.org/10.4187/respcare.06735 | Not a systematic review |
| Pisani L, Astuto M, Prediletto I, Longhini F. High flow through nasal cannula in exacerbated COPD patients: a systematic review. Pulmonology. 2019;25(6):348-54. Available from: https://doi.org/10.1016/j.pulmoe.2019.08.001 | Wrong intervention |
| Pisani L, Vega ML. Use of Nasal High Flow in Stable COPD: Rationale and Physiology. COPD. 2017;14(3):346-50. Available from: https://doi.org/10.1080/15412555.2017.1315715 | Not a systematic review |
| Pitre T, Abbasi S, Kachkovski GV, Burns L, Huan P, Mah J, et al. Home Respiratory Strategies in Patients With COPD With Chronic Hypercapnic Respiratory Failure. Respir Care. 2024;69(11):1457-67. Available from: https://doi.org/10.4187/respcare.11805 | Wrong intervention |
| Pitre T, Abbasi S, Su J, Mah J, Zeraatkar D. Home high flow nasal cannula for chronic hypercapnic respiratory failure in COPD: A systematic review and meta-analysis. Respir Med. 2023;219:107420. Available from: https://doi.org/10.1016/j.rmed.2023.107420 | Wrong intervention |
| Pitre T, Zeraatkar D, Kachkovski GV, Leung G, Shligold E, Dowhanik S, et al. Noninvasive Oxygenation Strategies in Adult Patients With Acute Hypoxemic Respiratory Failure: A Systematic Review and Network Meta-Analysis. Chest. 2023;164(4):913-28. Available from: https://doi.org/10.1016/j.chest.2023.04.022 | Wrong population |
| Puhan MA, Schunemann HJ, Frey M, Bachmann LM. Value of supplemental interventions to enhance the effectiveness of physical exercise during respiratory rehabilitation in COPD patients. A systematic review. Respir Res. 2004;5(1):25. Available from: https://doi.org/10.1186/1465-9921-5-25 | Wrong intervention |
| Rafael Henriques H, Correia A, Santos T, Faria J, Sousa D, Portela J, et al. Nursing interventions to promote dyspnea self-management of complex chronic patients: An integrated review. Int J Nurs Sci. 2024;11(2):241-57. Available from: https://doi.org/10.1016/j.ijnss.2024.03.008 | Wrong outcome |
| Ram FS, Wedzicha JA. Ambulatory oxygen for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2002(2):CD000238. Available from: https://doi.org/10.1002/14651858.CD000238 | Duplicate |
| Ram FS, Wedzicha JA. Ambulatory oxygen for people with chronic obstructive pulmonary disease who are not hypoxaemic at rest. Cochrane Database Syst Rev. 2014(6). Available from: https://doi.org/10.1002/14651858.CD000238.pub2 | Duplicate |
| Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, et al. Pulmonary rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest. 2007;131(5). Available from: https://doi.org/10.1378/chest.06-2418 | Not a systematic review |
| Rowe BH, Bhutani M, Stickland MK, Cydulka R. Assessment and management of chronic obstructive pulmonary disease in the emergency department and beyond. Expert Rev Respir Med. 2011;5(4):549-59. Available from: https://doi.org/10.1586/ers.11.43 | Not a systematic review |
| Sami R, Savari MA, Mansourian M, Ghazavi R, Meamar R. Effect of Long-Term Oxygen Therapy on Reducing Rehospitalization of Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Pulm Ther. 2023;9(2):255-70. Available from: https://doi.org/10.1007/s41030-023-00221-3 | Wrong intervention |
| Sarkar M, Madabhavi I, Kadakol N. Oxygen-induced hypercapnia: physiological mechanisms and clinical implications. Monaldi Arch Chest Dis. 2022;93(3). Available from: https://doi.org/10.4081/monaldi.2022.2399 | Not a systematic review |
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| Sin DD, McAlister FA, Man SF, Anthonisen NR. Contemporary management of chronic obstructive pulmonary disease: scientific review. JAMA. 2003;290(17):2301-12. Available from: https://doi.org/10.1001/jama.290.17.2301 | Wrong intervention |
| Skrepnek GH, Skrepnek SV. An assessment of therapeutic regimens in the treatment of acute exacerbations in chronic obstructive pulmonary disease and asthma. Am J Manag Care. 2004;10(5 Suppl):S139-52. | Not a systematic review |
| Stoller JK. Oxygen may reduce dyspnoea in people with COPD who have mild or no hypoxaemia. Evid Based Med. 2012;17(2):40-1. Available from: https://doi.org/10.1136/ebm.2011.100127 | Not a systematic review |
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| Taylor SJ, Candy B, Bryar RM, Ramsay J, Vrijhoef HJ, Esmond G, et al. Effectiveness of innovations in nurse led chronic disease management for patients with chronic obstructive pulmonary disease: systematic review of evidence. BMJ. 2005;331(7515):485. Available from: https://doi.org/10.1136/bmj.38512.664167.8F | Wrong intervention |
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| Uzun AB, Iliescu MG, Stanciu LE, Ionescu EV, Ungur RA, Ciortea VM, et al. Effectiveness of Intermittent Hypoxia-Hyperoxia Therapy in Different Pathologies with Possible Metabolic Implications. Metabolites. 2023;13(2). Available from: https://doi.org/10.3390/metabo13020181 | Wrong intervention |
| Wilt TJ, Niewoehner D, MacDonald R, Kane RL. Management of stable chronic obstructive pulmonary disease: a systematic review for a clinical practice guideline. Ann Intern Med. 2007;147(9):639-53. Available from: https://doi.org/10.7326/0003-4819-147-9-200711060-00009 | Wrong intervention |
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| Yang H, Huang D, Luo J, Liang Z, Li J. The use of high-flow nasal cannula in patients with chronic obstructive pulmonary disease under exacerbation and stable phases: A systematic review and meta-analysis. Heart Lung. 2023;60:116-26. Available from: https://doi.org/10.1016/j.hrtlng.2023.02.016 | Wrong intervention |
| Yang PL, Yu JQ, Chen HB. High-flow nasal cannula for acute exacerbation of chronic obstructive pulmonary disease: A systematic review and meta-analysis. Heart Lung. 2021;50(2):252-61. Available from: https://doi.org/10.1016/j.hrtlng.2020.12.010 | Wrong intervention |
| Yang Y, Liu TT, Li DM, Ren XL, Luo Z, Chen XL, et al. Adherence and influencing factors of high-flow nasal cannula humidified oxygen therapy in elderly patients with stable chronic obstructive pulmonary disease: A meta-analysis. Ann Thorac Med. 2025;20(1):49-55. Available from: https://doi.org/10.4103/atm.atm_151_24 | Wrong intervention |
| Yoon HK, Park YB, Rhee CK, Lee JH, Oh YM, Committee of the Korean CG. Summary of the Chronic Obstructive Pulmonary Disease Clinical Practice Guideline Revised in 2014 by the Korean Academy of Tuberculosis and Respiratory Disease. Tuberc Respir Dis (Seoul). 2017;80(3):230-40. Available from: https://doi.org/10.4046/trd.2017.80.3.230 | Not a systematic review |
| Zayed Y, Barbarawi M, Kheiri B, Haykal T, Chahine A, Rashdan L, et al. Initial Noninvasive Oxygenation Strategies in Subjects With De Novo Acute Hypoxemic Respiratory Failure. Respir Care. 2019;64(11):1433-44. Available from: https://doi.org/10.4187/respcare.06981 | Wrong population |
| Zhang H, Chen XW, Guo J, Sun M. Evidence summary of oxygen therapy management in patients with chronic obstructive pulmonary disease. Chinese Journal of Nursing Education. 2021;18(8). Available from: https://doi.org/10.3761/j.issn.1672-9234.2021.08.014 | Wrong language |
| Zhang L, Wang Y, Ye Y, Gao J, Zhu F, Min L. Comparison of High-Flow Nasal Cannula with Conventional Oxygen Therapy in Patients with Hypercapnic Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Int J Chron Obstruct Pulmon Dis. 2023;18:895-906. Available from: https://doi.org/10.2147/COPD.S402506 | Wrong intervention |
| Zhang Y, Fang C, Dong BR, Wu T, Deng JL. Oxygen therapy for pneumonia in adults. Cochrane Database Syst Rev. 2012;2012(3):CD006607. Available from: https://doi.org/10.1002/14651858.CD006607.pub4 | Wrong intervention |
D1 = Step 1; D2= Step 2; D3 = Step 3; D4 = Step 4; D5 = Step 5 = High;  = Moderate;  = Low;  =unclear |
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| Study | D1 | D2 | D3 | D4 | D5 | Overall |
| Ekström | |
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The risk of bias in included systematic reviews is appraised using an assessment tool based on AMSTAR revised by SBU. The assessment tool is comprised of six steps based on the items in AMSTAR. To be assessed as low risk of bias, a systematic review has to fulfil all requirements for step 1 to 6. A systematic review is of moderate risk of bias if it fulfils all the requirements up to step 4. Systematic reviews that do not meet the requirements in one of the steps 1-4 are not assessed further than that step and has a high risk of bias.