title: Does palliative home oxygen improve dyspnoea? A consecutive cohort study.
abstract: Palliative oxygen for refractory dyspnoea is frequently prescribed, even when the criteria for long-term home oxygen (based on survival, rather than the symptomatic relief of breathlessness) are not met. Little is known about how palliative home oxygen affects symptomatic breathlessness. A 4-year consecutive cohort from a regional community palliative care service in Western Australia was used to compare baseline breathlessness before oxygen therapy with dyspnoea sub-scales on the symptom assessment scores (SAS; 0-10) 1 and 2 weeks after the introduction of oxygen. Demographic and clinical characteristics of people who responded were included in a multi-variable logistic regression model. Of the study population (n = 5862), 21.1% (n = 1239) were prescribed oxygen of whom 413 had before and after data that could be included in this analysis. The mean breathlessness before home oxygen was 5.3 (SD 2.5; median 5; range 0-10). There were no significant differences overall at 1 or 2 weeks (P = 0.28) nor for any diagnostic sub-groups. One hundred and fifty people (of 413) had more than a 20% improvement in mean dyspnoea scores. In multi-factor analysis, neither the underlying diagnosis causing breathlessness nor the demographic factors predicted responders at 1 week. Oxygen prescribed on the basis of breathlessness alone across a large population predominantly with cancer does not improve breathlessness for the majority of people. Prospective randomised trials in people with cancer and non-cancer are needed to determine whether oxygen can reduce the progression of breathlessness compared to a control arm.
authors.affiliation: Department of Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia. david.currow@flinders.edu.au
authors.forename: D C
authors.initials: DC
authors.lastname: Currow
authors.forename: M
authors.initials: M
authors.lastname: Agar
authors.forename: J
authors.initials: J
authors.lastname: Smith
authors.forename: A P
authors.initials: AP
authors.lastname: Abernethy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004417:Dyspnea / Q000523:psychology / Q000628:therapy*; D005260:Female; D006333:Heart Failure / Q000150:complications; D006699:Home Care Services; D006738:Hospices; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000627:therapeutic use*; D010166:Palliative Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011788:Quality of Life / Q000523:psychology; D012131:Respiratory Insufficiency / Q000150:complications; D014904:Western Australia; D055815:Young Adult
chemical_list: D010100:Oxygen