Use of supplemental oxygen in patients with pulmonary arterial hypertension in REVEAL
2018
Background Supplemental low-flow oxygen is recommended by treatment guidelines as supportive therapy for patients with pulmonary arterial hypertension (PAH), based largely on expert opinion. Reduced
diffusing capacityof lung carbon monoxide (
DLCO) is associated with increased mortality in PAH. Reduced
DLCOis also associated with relative
hypoxemia, making the effects of supplemental oxygen use of particular interest in this sub-population. Methods Patients in the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL), a 5-year
observational studyof Group 1 PAH, were categorized by presence or absence of supplemental oxygen use and by degree of
DLCOreduction. Kaplan–Meier survival estimates were calculated by group. Results Of 3,046 patients, 57% used supplemental oxygen and 43% did not. Supplemental oxygen users had worse prognostic factors and more PAH-specific medication use. Of the 424 patients with severe
DLCOreduction ( p = 0.0033). This was true for newly diagnosed and previously diagnosed patients. There was no relationship between oxygen use and outcomes in patients with no, mild, or moderate
DLCOreduction. Conclusions In this
observational study, the risk of death was significantly lower for patients with severe
DLCOreduction who received supplemental oxygen compared with those who did not. A randomized trial is warranted to further investigate the relationship between supplemental oxygen use and outcomes in PAH.
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