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<a href="http://doi.org/10.1016/S0140-6736(10)61115-4" target="_blank" rel="noreferrer">http://doi.org/10.1016/S0140-6736(10)61115-4</a>
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Title
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Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial
Publisher
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Lancet
Date
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2010
Subject
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Female; Humans; Male; United States; Great Britain; Adult; Aged; Middle Aged; Treatment Outcome; Australia; Sleep Stages; Double-Blind Method; quality of life; Palliative Care/methods; Sleep; Air; Anxiety/chemically induced; Dyspnea/drug therapy/therapy; Epistaxis/chemically induced; Oxygen/administration & dosage/adverse effects/blood
Creator
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Abernethy AP; McDonald CF; Frith PA; Clark K; Herndon JE; Marcello J; Young IH; Bull J; Wilcock A; Booth S; Wheeler JL; Tulsky JA; Crockett AJ; Currow DC
Description
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BACKGROUND: Palliative oxygen therapy is widely used for treatment of dyspnoea in individuals with life-limiting illness who are ineligible for long-term oxygen therapy. We assessed the effectiveness of oxygen compared with room air delivered by nasal cannula for relief of breathlessness in this population of patients. METHODS: Adults from outpatient clinics at nine sites in Australia, the USA, and the UK were eligible for enrolment in this double-blind, randomised controlled trial if they had life-limiting illness, refractory dyspnoea, and partial pressure of oxygen in arterial blood (PaO(2)) more than 7.3 kPa. Participants were randomly assigned in a 1:1 ratio by a central computer-generated system to receive oxygen or room air via a concentrator through a nasal cannula at 2 L per min for 7 days. Participants were instructed to use the concentrator for at least 15 h per day. The randomisation sequence was stratified by baseline PaO(2) with balanced blocks of four patients. The primary outcome measure was breathlessness (0-10 numerical rating scale [NRS]), measured twice a day (morning and evening). All randomised patients who completed an assessment were included in the primary analysis for that data point (no data were imputed). This study is registered, numbers NCT00327873 and ISRCTN67448752. FINDINGS: 239 participants were randomly assigned to treatment (oxygen, n=120; room air, n=119). 112 (93%) patients assigned to receive oxygen and 99 (83%) assigned to receive room air completed all 7 days of assessments. From baseline to day 6, mean morning breathlessness changed by -0.9 points (95% CI -1.3 to -0.5) in patients assigned to receive oxygen and by -0.7 points (-1.2 to -0.2) in patients assigned to receive room air (p=0.504). Mean evening breathlessness changed by -0.3 points (-0.7 to 0.1) in the oxygen group and by -0.5 (-0.9 to -0.1) in the room air group (p=0.554). The frequency of side-effects did not differ between groups. Extreme drowsiness was reported by 12 (10%) of 116 patients assigned to receive oxygen compared with 14 (13%) of 108 patients assigned to receive room air. Two (2%) patients in the oxygen group reported extreme symptoms of nasal irritation compared with seven (6%) in the room air group. One patient reported an extremely troublesome nose bleed (oxygen group). INTERPRETATION: Since oxygen delivered by a nasal cannula provides no additional symptomatic benefit for relief of refractory dyspnoea in patients with life-limiting illness compared with room air, less burdensome strategies should be considered after brief assessment of the effect of oxygen therapy on the individual patient. FUNDING: US National Institutes of Health, Australian National Health and Medical Research Council, Duke Institute for Care at the End of Life, and Doris Duke Charitable Foundation.
2010
Identifier
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<a href="http://doi.org/10.1016/S0140-6736(10)61115-4" target="_blank" rel="noreferrer">10.1016/S0140-6736(10)61115-4</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
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Journal Article
2010
Abernethy AP
Adult
Aged
Air
Anxiety/chemically induced
Australia
Backlog
Booth S
Bull J
Clark K
Crockett AJ
Currow DC
Double-Blind Method
Dyspnea/drug therapy/therapy
Epistaxis/chemically induced
Female
Frith PA
Great Britain
Herndon JE
Humans
Journal Article
Lancet
Male
Marcello J
McDonald CF
Middle Aged
Oxygen/administration & dosage/adverse effects/blood
Palliative Care/methods
Quality Of Life
Sleep
Sleep Stages
Treatment Outcome
Tulsky JA
United States
Wheeler JL
Wilcock A
Young IH