The unresolved issue of oxygen therapy in lung fibrosis: Some clues from a Spanish cohort

Irene Martin-Robles, Eva Balcells, Amalia Moreno, Vanesa Vicens-Zygmunt, Ana Villar, Alejandra Marin, Esteban Cano, Alejandro Robles, Antonio Xaubet, Sergi Marti, Diego Castillo, Maria Molina-Molina

Abstract


Indication of oxygen therapy in fibrotic interstitial lung diseases is not standardized and its specific requirements are not well defined. The objective of this study was to evaluate ambulatory oxygen therapy features in lung fibrotic patients. Clinical and exploratory　data, including 6-minute walking test and pulmonary hypertension, from one hundred and seven patients with fibrotic interstitial lung disease that received ambulatory oxygen treatment were studied. In up to 40% of cases the prescription of oxygen therapy was made after performing a 6-minute walking test. Patients who required ambulatory oxygen only during exercise presented a mild to moderate reduction of the predicted % FVC (62.1 ± 19) and DLCO (49 ± 14.4) while patients who had respiratory failure at rest (mean PaO2 51.9 ± 6.7) presented a moderate reduction of %FVC (56.8 ± 15.6) but a severe decrease of %DLCO (31.67 ± 12). Pulmonary hypertension (PH) was evaluated in 47.7% of patients and occurred in 60.8% of them. In conclusion, there is no pulmonary functional predictor of oxyhaemoglobin desaturation during exercise. PH is frequently associated with interstitial lung diseases, mainly when respiratory failure at rest appears. The heterogeneity of the patients and limitation of retrospective studies could be the cause of the tributes for potential benefits of oxygen treatment in interstitial lung diseases.


Keywords


Interstitial lung disease, oxygen therapy, 6-minute walking test, pulmonary hypertension

Full Text:

PDF

References


An Official American Thoracic Society/European Respiratory Society Statement: Update of the International Multidisciplinary Classification of the Idiopathic Interstitial Pneumonias. Am J Respir Crit Care Med 188:733-748, 2013.

An official ATS/ERS/JRS/ALAT statement: idio-pathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 183:788-824, 2011.

Selman M, King TE Jr, Pardo A. Idiopathic pul-monary fibrosis: prevailing and evolving hypotheses about its pathogenesis and implications for therapy. Ann Intern Med 134:136-151, 2001.

Xaubet A, Ancochea J, Blanquer R, Montero C, Morell F, Rodríguez Becerra E, Sueiro A y Villena V. Diagnóstico y tratamiento de las enfermedades pulmonares intersticiales difusas. Arch Bronconeumol 39:580-600, 2003.

Fellrath JM, du Bois RM. Idiopathic pulmonary fibrosis/cryptogenic fibrosis alveolitis. Clin Exp Med 3:65-83, 2003.

Nathan SD, Noble PW, Tuder RM. Idiopathic pulmonary fibrosis and pulmonary hypertension: connecting the dots. Am J Respir Crit Care Med 175:875-880, 2007.

Miyamoto S, Nagaya N, Satoh T, Kyotami S, Sakamaki F, Fujita M, Nakanishi M, Miyatake K. Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension: Comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med 161:487-492, 2000.

Sun XG, Hansen JE, Oudiz RJ, Wasserman K. Exercise pathophysiology in patients with primary pulmonary hypertension. Circulation 104:429-435, 2001.

Eaton T, Young P, Milne D, Wells AU. Six-minute walk, maximal exercise tests: reproducibility in fibrotic interstitial pneumonia. Am J Respir Crit Care Med 171: 1150–1157, 2005.

Turner SE, Eastwood PR, Cecins NM, Hillman DR, Jenkins SC. Physiologic responses to incremental and self-paced exercise in COPD: a comparison of three tests. Chest 126: 766–773, 2004.

Blanco I, Villaquirán C, Valera JL, Molina-Molina M, Xaubet A, Rodríguez-Roisin R, Barberá A y Roca J. Peak Oxygen Uptake During the Six-minute Walk Test in Diffuse Interstitial Lung Disease and Pulmonary Hypertension. Arch Bronconeumol 46:122-128, 2010.

Visca D, Montgomery A, De Lauretis A, Sestini P, Soteriou H, Maher TM, Wells AU, Renzoni EA. Ambulatory oxygen in interstitial lung disease. Eur Respir J 38:987-990, 2011.

Frank RC, Hicks S, Duck AM, Spencer L, Leonard CT, Barnett E. Ambulatory oxygen in idiopathic pulmonary fibrosis: of what benefit? Eur Pespir 40:269-70, 2012.

Doherty DE, Petty TL, Bailey W, Carlin B, Cassaburi R, Christopher K, Kvale P, Make B, Mapel D, Selecky P, Tiger J. Recommendations of the 6th long-term oxygen therapy consensus conference. Respir Care 51:519-525, 2006.

Agustí AG, Roca J, Gea J, Wagner PD, Xaubet A, Rodríguez-Roisin R. Mechanisms of gas-exchange impairtment in idiopathic pulmonary fibrosis. Am Rev Respir Dis 143:219-225, 1991.

Hansen JE, Wasserman K. Pathophysiology of activity limitation in patients with interstitial lung disease. Chest 109:1566-1576, 1996.

Wells AU, Hogaboam CM. Update in Diffuse Parenchymal Lung Disease 2006. Am J Respir Crit Care Med 175:655-660, 2007.

Flaherty KR, Andrei A-C, Murray S, Fraley C, Colby TV, Travis WD, Lama V, Kazerooni EA, Gross BH, Toews GB, Martinez FJ. Idiopathic pulmonary fibrosis: prognostic value of changes in physiology and six minute walk test. Am J Resp Crit Care Med 174:803-809, 2006.

Lederer DJ, Arcasoy SM, Wilt JS, D´Ovidio F, Sonett JR, Kawut SM. Six-minute-walk distance predicts waiting list survival in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 174:659-664, 2006.

Lettieri CJ, Nathan SD, Barnett SD, Ahmad S, Shorr AF. Prevalence and outcomes of pulmonary arterial hypertension in advanced idiopathic pulmonary fibrosis. Chest 129:746-752, 2006.

Hamada K, Nagai S, Tanaka S, Handa T, Shigematsu M, Nagao T, Mishima M, Kitaichi M, Izumi T. Significance of pulmonary arterial pressure and diffusion capacity of the lung as prognosticator in patients with idiopathic pulmonary fibrosis. Chest 131:650-656, 2007.

Nadrous HF, Pellikka PA, Krowka MJ, Swanson KL, Chaowalit N, Decker PA, Ryu JH. Pulmonary hypertension in patients with idiopathic pulmonary fibrosis. Chest 128:2393-2399, 2005.


Refbacks

  • There are currently no refbacks.