Oxygen therapy in the pre-hospital setting for acute exacerbations of chronic obstructive pulmonary disease

People with Chronic obstructive pulmonary disease (COPD) are prone to sudden episodes where their symptoms become worse and oxygen levels may fall. Initial treatment during these episodes usually includes oxygen, but this may cause a rise in the carbon dioxide levels that can be dangerous. This review could not find any evidence to indicate the safest way to provide oxygen treatment in this circumstance.

Authors' conclusions: 

No relevant trials have been published to date, so there is no evidence to indicate whether different oxygen therapies in the pre-hospital setting have an effect on outcome for people with acute exacerbations of COPD. There is an urgent need for robust, well-designed randomised controlled trials to investigate the effect of oxygen therapies in the pre-hospital setting for people with acute exacerbations of COPD.

Read the full abstract...

Chronic obstructive pulmonary disease (COPD), a leading cause of morbidity and mortality in the developed world, is characterised by acute deterioration in symptoms. During these exacerbations, people are prone to developing alveolar hypoventilation, which may be contributed to by the administration of high inspired oxygen concentrations.


The objective of the review was to determine the effect of different inspired oxygen concentrations ("high flow" compared to "controlled") in the pre-hospital setting on outcome for people with acute exacerbations of COPD.

Search strategy: 

We searched the Cochrane Airways Group Specialised Register (CENTRAL), MEDLINE, EMBASE and CINAHL and reference lists of articles. We also contacted authors of identified RCTs for details of other relevant, published and unpublished studies. The most recent search was conducted in August 2008.

Selection criteria: 

Randomised controlled trials comparing oxygen therapy at different concentrations or oxygen therapy versus placebo in the pre-hospital setting for treatment of acute exacerbations of COPD were eligible.

Data collection and analysis: 

Two review authors independently assessed trial quality and extracted data.

Main results: 

The search identified a total of 741 abstracts, of which 18 were selected as potentially relevant, only two of the 18 studies were randomised controlled trials and eligible for inclusion in the review, but were ongoing and had no data available for analysis.