Long-term oxygen therapy appears to be a safe means of treating hypoxemia. It can provide many physiologic improvements and prolongs life in persons with severe chronic arterial hypoxemia at rest. Recent studies suggest that arterial hypoxia is common during exercise and sleep, and it is likely that some patients with intermittent desaturation would benefit physiologically from supplemental oxygen. Oxygen is an expensive drug, and we do not know whether its benefits are greater than its costs in patients who are not hypoxic at rest. I believe that low-flow oxygen administered as continuously as possible should be strongly considered for all patients whose Pao2 is 55 mm Hg or less at rest, regardless of whether they have cor pulmonale, and for all patients with cor pulmonale, regardless of their Pao2.
Nocturnal Oxygen Therapy Trial Group. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease. A clinical trial. Ann Intern Med1980;93:391–398.
2.
LenfantC, SullivanK.Adaptation to high altitude. N Engl J Med1971;284:1298–1309.
3.
HeathD, WilliamsDR. Man at high altitude. Edinburgh: Churchill Livingstone, 1977.
4.
LuceJM, CulverBH. Respiratory muscle function in health and disease. Chest1982;81:82–90.
5.
LuceJM. Respiratory complications of obesity. Chest1980;78:626–631.
6.
HinshawHC, MurrayJF. Diseases of the chest. 4th ed. Philadelphia: WB Saunders Co, 1980.
7.
BradleyBL, GarnerAE, BilliuD, MestasJM, FormanJ.Oxygen-assisted exercise in chronic obstructive lung disease. Am Rev Respir Dis1978;118:239–243.
8.
MinhV-D, LeeHM, DolanGF, LightRW, BellJ, VasquezP.Hypoxemia during exercise in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis1979;120:787–794.
9.
KooKW, SaxDS, SniderGL. Arterial blood gases and pH during sleep in chronic obstructive pulmonary disease. Am J Med1975;58:663–670.
10.
FlickMR, BlockAJ. Continuous in-vivo monitoring of arterial oxygenation in chronic obstructive lung disease. Ann Intern Med1977;86:725–730.
11.
WynneJW, BlockAJ, HemenwayJ, HuntLA, FlickMR. Disordered breathing and oxygen desaturation during sleep in patients with chronic obstructive lung disease (COLD). Am J Med1979;66:573–579.
12.
KearleyR, WynneJW, BlockAJ, BoysenPG, LindseyS, MartinC.The effect of low flow oxygen on sleep-disordered breathing and oxygen desaturation. Chest1980;78:682–685.
13.
LittnerMR, McGintyDJ, ArandDL. Determinants of oxygen desaturation in the course of ventilation during sleep in chronic obstructive pulmonary disease. Am Rev Respir Dis1980;122:849–857.
14.
BlockAJ, BoysenPG, WynneJW, HuntLA. Sleep apnea, hypopnea and oxygen desaturation in normal subjects. A strong male predominance. N Engl J Med1979;300:513–517.
15.
LevineBE, BigelowDB, HamstraRD, et al. The role of long-term continuous oxygen administration in patients with chronic airway obstruction with hypoxemia. Ann Intern Med1967;66:639–650.
16.
PettyTL, FiniganMM. Clinical evaluation of prolonged ambulatory oxygen therapy in chronic airway obstruction. Am J Med1968;45:242–252.
17.
BlockAJ, CastleJR, KeittAS. Chronic oxygen therapy. Treatment of chronic obstructive pulmonary disease at sea level. Chest1974;65:279–288.
18.
FishmanAP. Hypoxia on the pulmonary circulation. Circ Res1976;38:221–231.
19.
GlazierJB, MurrayJF. Sites of pulmonary vasomotor reactivity in the dog during alveolar hypoxia and serotonin and histamine infusion. J Clin Invest1971;50:2550–2558.
20.
BergofskyEH, BassBG, FerrettiR, FishmanAP. Pulmonary vasoconstriction in response to precapillary hypoxemia. J Clin Invest1963;42:1201–1215.
21.
BoysenPG, BlockAJ, WynneJW, HuntLA, FlickMR. Nocturnal pulmonary hypertension in patients with chronic obstructive pulmonary disease. Chest1979;76:536–542.
GazetopoulosN, SalonikidesN, DaviesH.Cardiopulmonary function in patients with pulmonary hypertension. Br Heart J1974;36:19–28.
24.
BurrowsB, KettelLJ, NidenAH, RabinowitzM, DienerCF. Patterns of cardiovascular dysfunction in chronic obstructive lung disease. N Engl J Med1972;286:912–918.
25.
FishmanAP. Chronic cor pulmonale. Am Rev Respir Dis1976;114:775–794.
26.
AbrahamAS, ColeRB, BishopJM. Reversal of pulmonary hypertension by prolonged oxygen administration to patients with chronic bronchitis. Circ Res1968;23:147–157.
27.
StarkRD, FinneganP, BishopJM. Daily requirement of oxygen to reverse pulmonary hypertension in patients with chronic bronchitis. Br Med J1972;3:724–728.
28.
StarkRD, FinneganP, BishopJM. Long-term domiciliary oxygen in chronic bronchitis with pulmonary hypertension. Br Med J1973;3:467–470.
29.
MurphyML, AdamsonJ, HutchesonF.Left ventricular hypertrophy in patients with chronic bronchitis and emphysema. Ann Intern Med1974;81:307–313.
30.
HudsonLD, KurtTL, PettyTL, GentonE.Arrhythmias associated with acute respiratory failure in patients with chronic airway obstruction. Chest1973;63:661–665.
31.
FlickMR, BlockAJ. Nocturnal vs diurnal cardiac arrhythmias in patients with chronic obstructive pulmonary disease. Chest1979;75:8–11.
32.
TirlapurVG, MirMA. Nocturnal hypoxemia and associated electrocardiographic changes in patients with chronic obstructive airways disease. N Engl J Med1982;306:125–130.
33.
VanierT, DulfanoMJ, WuC, DesforgesJF. Emphysema, hypoxia and the polycythemic response. N Engl J Med1963;269:169–178.
34.
BlockAJ. Low flow oxygen therapy. Treatment of the ambulant outpatient. Am Rev Respir Dis1974;110(part 2):71–88.
35.
YorkEL, JonesRL, MenonD, SprouleBJ. Effects of secondary polycythemia on cerebral blood flow in chronic obstructive pulmonary disease. Am Rev Respir Dis1980;121:813–818.
36.
ChamberlainDA, MillardFJC. The treatment of polycythaemia secondary to hypoxic lung disease by continuous oxygen administration. Q J Med1963;32:341–350.
37.
KropHD, BlockAJ, CohenE.Neuropsychologic effects of continuous oxygen therapy in chronic obstructive pulmonary disease. Chest1973;64:317–322.
RenzettiADJr, McClementJH, LittBD. The Veterans Administration Cooperative Study of Pulmonary Function. III. Mortality in relation to respiratory function in chronic obstructive pulmonary disease. Am J Med1966;41:115–129.
40.
NeffTA, PettyTL. Long-term continuous oxygen therapy in chronic airway obstruction. Mortality in relationship to cor pulmonale, hypoxia and hypercapnia. Ann Intern Med1970;72:621–626.
41.
FleethamJA, BradleyCA, KrygerMH, AnthonisenNR. The effect of low flow oxygen therapy on the chemical control of ventilation in patients with hypoxemic COPD. Am Rev Respir Dis1980;122:833–840.
42.
AubierM, MurcianoD, Milic-EmiliJ, et al. Effects of the administration of O2 on ventilation and blood gases in patients with chronic obstructive pulmonary disease during acute respiratory failure. Am Rev Respir Dis1980;122:747–754.
43.
NashG, BlennerhassettJB, PontoppidanH.Pulmonary lesions associated with oxygen therapy and artificial ventilation. N Engl J Med1967;276:368–374.
44.
PettyTL, StanfordRE, NeffTA. Continuous oxygen therapy in chronic airway obstruction. Observations on possible oxygen toxicity and survival. Ann Intern Med1971;75:361–367.
