Long-term Oxygen Treatment Trial

Inclusion Criteria

• Age at least 40 years
• COPD
• Dyspnea, determined by Modified Medical Research Council (MMRC) scale of at least 1
• Dyspnea and lung disease process dominated by COPD in judgment of the study physician
• Participant must meet one of the following:
• Post-bronchodilator forced expiratory volume in 1 second (FEV1) percent less than or equal to 70% predicted
• Post-bronchodilator forced expiratory volume in 1 second (FEV1) percent >70% predicted and LOTT study physician determines that there is radiologic evidence of emphysema
• Post-bronchodilator FEV1/forced vital capacity (FVC) less then 0.70
• Participant must meet either of the following oxygen saturation criteria:
• Oxygen saturation of at least 89% and no greater than 93% after sitting quietly on room air, without hyperventilation and without pursed lips breathing during oximetry
• Resting oxygen saturation 94% or greater and desaturation during exercise defined as saturation below 90% for at least 10 seconds during the 6 minute walk test
• If participant is on supplemental oxygen at the start of screening, all of the following must be met prior to randomization:
• Participant agrees to stop using oxygen if randomized to no oxygen
• Participant's physician agrees in writing to rescind order for oxygen if participant is randomized to no oxygen
• Participant must report not using oxygen on the day of randomization and must report not using oxygen for the 4 calendar days prior to randomization
• Satisfactory resolution of logistics of continuation with same oxygen company with waiver of cost sharing obligations or switch to new company that will waive cost sharing obligations if participant is randomized to oxygen
• At least 10 pack-years of tobacco cigarette smoking before study entry
• Agreement not to smoke while using supplemental oxygen
• Medicare beneficiary with both Part A and Part B coverage or insurance OR personally willing to cover costs typically covered by Medicare
• Approval of study physician for randomization to either treatment group
• Completion of all required prerandomization assessments within 60 days of initiating study entry
• Randomization within 60 days of initiating eligibility evaluation
• Consent

Exclusion Criteria

• Less than 30 days post treatment for acute exacerbation of COPD as of initiating eligibility evaluation (less than 30 days from last dose of antibiotics or since a new or increased dose of systemic corticosteroids was initiated); chronic use of systemic corticosteroids while health is stable is not exclusionary
• COPD exacerbation requiring antibiotics, new or increased dose of systemic corticosteroids, or oxygen treatment after screening starts and prior to randomization (chronic use of corticosteroids while health is stable is not exclusionary)
• Less than 30 days post discharge from an acute care hospital after acute care hospitalization for COPD or other condition, as of initiating eligibility evaluation (participant may be in a rehab hospital at time of screening)
• New prescription of supplemental oxygen after screening starts and before randomization
• Thoracotomy, sternotomy, major cardiopulmonary intervention (e.g., lung resection, open heart surgery, etc.), or other procedure in the 6 months before study entry likely to cause instability of pulmonary status
• Non-COPD lung disease that affects oxygenation or survival
• Epworth Sleepiness Scale score greater than 15
• Desaturation below 80% for at least 1 minute during the 6-minute walk test
• Disease or condition expected to cause death, inability to perform procedures for the trial, or inability to comply with therapy within 6 months of random assignment, as judged by the study physician
• Participation in another intervention study