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Does palliative home oxygen improve dyspnoea? A consecutive cohort study

Department of Palliative and Supportive Services, Flinders University, Bedford Park, South Australia; Institute for Palliative and Supportive Care Research, david.currow{at}flinders.edu.au

M Agar

Department of Palliative and Supportive Services, Flinders University, Bedford Park, South Australia; Institute for Palliative and Supportive Care Research

J Smith

Silver Chain Nursing Association, Perth, Western Australia

AP Abernethy

Department of Palliative and Supportive Services, Flinders University, Bedford Park, South Australia; Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, North Carolina

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.

Key Words: dyspnoea • care • oxygen inhalational therapy • palliative • respiratory • respiratory system • signs and symptoms

This version was published on June 1, 2009

Palliative Medicine, Vol. 23, No. 4, 309-316 (2009)
DOI: 10.1177/0269216309104058


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