Continuous supplemental oxygen should be used to improve exercise performance and survival in patients with moderate to severe COPD who have severe daytime hypoxemia (arterial oxygen pressure less than 55 mm Hg or oxygen saturation [SaO 2 ] less than 88 percent). There also is evidence for improvement in endurance and exercise capacity with supplemental oxygen. There is no improvement in mortality when oxygen is used for patients with mild hypoxemia or nocturnal hypoxemia alone. One systematic review of RCTs found that continuous supplemental oxygen improved survival compared with nocturnal oxygen or no oxygen when used for 24 months in patients with an SaO 2 less than 88 percent. 32 Similarly, a Cochrane review identified 27 RCTs that showed better endurance and exercise capacity with the use of supplemental oxygen in participants who had moderate to severe COPD. 33 However, the individual trials had small sample sizes, and there may have been publication bias.
"In sharp contrast to the leading clinical guidelines, the vast majority of patients hospitalized for acute exacerbation of COPD were initially treated with high doses of corticosteroids administered intravenously," conclude study researchers led by Peter K. Lindenauer, MD, of Baystate Medical Center in Springfield, Mass. This practice is not associated with "any measurable benefit and at the same time exposes patients to the risks and inconvenience of an intravenous line, potentially unnecessarily high doses of steroids, greater hospital costs, and longer lengths of stay."