Not according to a randomised trial of supplemental oxygen for patients with severe resting hypoxaemia.

Current guidelines recommend at least 15 hours of long-term oxygen therapy for patients with chronic lung disease and severe hypoxemia (NEJM JW Gen Med Feb 15 2021 and Am J Respir Crit Care Med 2020; 202: e121-e141), with suggestions to extend oxygen therapy to 24 hours (Thorax 2015; 70 [Suppl 1]: i1-43).

To determine if nine additional hours of therapy daily offers clinical benefits, Swedish investigators performed a randomised trial to compare 24-hour and 15-hour oxygen therapy in 241 patients (mean age, 77 years) with severe hypoxaemia (PaO2 below 55 mmHg or SpO2 below 88% while breathing room air; or PaO2 below 60 mmHg plus signs of heart failure or polycythaemia [haematocrit, above 0.54]). Chronic obstructive pulmonary disease was the most common indication (more than 60%). The 15-hour group was instructed to use supplemental oxygen while sleeping at night and not to use it for a total of nine hours during the day. Adherence to therapy and follow up were excellent.

The incidence of the primary composite outcome (hospitalisation or all-cause death within one year) was identical in the two groups – 64%. Additional data suggested no significant differences in secondary out- comes, such as patient-reported measures of breathlessness, fatigue or well-being. 

Comment: These findings provide a clear message: extending oxygen therapy to 24 hours daily offers no survival or hospitalisation benefit compared with a 15-hour regimen. These results should reassure prescribers of long-term oxygen therapy and their patients that the burdens of 24-hour oxygen therapy, such as restricted mobility and social isolation, are not justified.

Raja-Elie E. Abdulnour, MD, Assistant Professor of Medicine, Harvard Medical School, Boston, USA; Editor for Clinical Development and AI Innovation, NEJM Group.

Ekström M, et al. Long-term oxygen therapy for 24 or 15 hours per day in severe hypoxemia. N Engl J Med 2024; 391: 977-988.

The summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Hospital Medicine