Whither Long-Term Oxygen Therapy -The Importance of the LOTT Results-

5 thoughts on “Whither Long-Term Oxygen Therapy -The Importance of the LOTT Results-

  1. Bruce Buckner says:

    The LOTT study had many problems, some of the most glaring

    1. The mean time of subject participation was 18 month (hardly enough to assess long term effects) and while some participated for 5 years, this means that more participated for far less than the 1.5 year avg.

    2. The avg BMI of subjects was 28.4 There were 0 subjects with a BMI <22. This means there were no underweight emphysema patients studied.

    3. There were very few subjects with Stage 4 COPD. 83% of the subjects had a FEV1 >30%

    4. Over 73% of the subjects were male although we know females tend to progress faster.

    1. PERF says:

      I appreciate Mr. Bender’s comment. All of the issues he raises are valid observations, but not necessarily “problems”. All clinical trials must be interpreted in light of the characteristics of the subjects who were studied and in light of the study design. It is relevant that subgroup analysis (e.g., men vs. women, high vs. low FEV1) failed to identify any subgroups that reaped benefit from the intervention.
      ~ Rich Casaburi

  2. Bruce Buckner says:

    “All clinical trials must be interpreted in light of the characteristics of the subjects who were studied and in light of the study design”

    This study was designed to look at RESTING moderate hypoxia. The conclusions drawn about a group added midway through (exercise induced hypoxia) must be interpreted with skepticism.

    When a major phenotype of the disease is excluded entirely (underweight BMI <22) and subgroup analysis doesn't differentiate between original study subjects and amended study subjects (who were studied for much shorter terms) such analysis becomes much less relevant.

    The fact that this study was amended midway and even then less than 25% of the number of subjects in the original design were recruited (738 rather than 3000) makes the smaller numbers in such subgroups and the much shorter observation time of those added subject to greater statistical error.

    We are still awaiting the results of analysis of the coronary and cognitive health of the subjects but one must wonder why the study was released now, rather than allowing all subjects to be studied the full five years and all facets of the subjects health analysed.

  3. Gladys Birk says:

    I would like to know if stage 4 is the last stage of COPD and how does the Doctor determine what stage you are in? I read all your pulmonary blog information in order to educate myself! I do not see a Pulmonary Speaclists . My PCP seems to think there is nothing more can be done than he is doing and I am inclined to believe him after reading and educationing myself. I am on SYMICORT, SPRIVA, NEBULIZER, and HOME OXYGEN, I know the signs of a flare up, I call my PCP and he prescribes me presidione and an antibodic , if I catch this in time it keeps me
    Out of the hospital, now that I know the signs I have not been in hospital for six years! I know there is no cure, just would like to know what stage I am in as I can no longer do most things I use to do and am getting weaker as far as ex: lifting a gallon of milk . Thank you for all your information, I have learned more about COPD from Dr. Richard Casaburi PHD, MDand this website than any where else, by reading the monthly PERF newsletter and watching the videos!!

    1. PERF says:

      Dear Gladys,
      Thanks very much for writing, and for your kind words. In COPD, the “stage” is determined by spirometry. A spirometer is the machine you blow into that determines how fast you’re able to blow out…how much air you’re able to blow out in one second. In stage 4, the amount of air blown out in the first second is 30% or less than would be predicted for a healthy person of similar age, height and gender. Pretty bad, but some people can function pretty well despite this. The trick is to keep active. The other trick, that you’ve apparently mastered, is to keep from getting sick; six years without a hospitalization is a good thing!
      Best wishes for a healthy and happy 2017.
      ~ Rich Casaburi

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