Portable low-flow nasal oxygen versus ambient air in patients with chronic lung disease and exercise-induced hypoxaemia: a randomised controlled crossover non-inferiority trial.

Authors

Mona Lichtblau, Carmen Wick, Anna Titz, Julian Müller, Simon Raphael Schneider, Dinah Hertig, Zoe Bousraou, Alessandro Vella, Michael Furian, Malcolm Kohler, Esther Irene Schwarz, Silvia Ulrich

Published in

BMJ open respiratory research. Volume 13. Issue 1. Sep 21, 2026. Epub Sep 21, 2026.

Abstract

Exercise-induced desaturation is a common symptom in chronic lung disease (CLD) and is associated with functional limitation and increased mortality. Although portable low-flow supplemental oxygen therapy (SOT) is commonly prescribed for exercise-induced hypoxaemia, evidence for SOT to improve performance is inconsistent.
This pragmatic, randomised, controlled, non-inferiority crossover trial enrolled patients with chronic obstructive pulmonary and interstitial lung disease who exhibited exercise-induced oxygen desaturation of >3%. Each patient performed two 6-minute walk distance (6MWD) tests in randomised order: one breathing ambient air and one using low-flow SOT delivered by a portable backpack concentrator (1-2 L/min). The primary outcome was 6MWD, secondary outcomes included perceived exertion and preference of the interventions. A predefined non-inferiority margin of 35 m was used.
Forty patients were enrolled (mean age 66±13 years; 14 women; 20 with chronic obstructive pulmonary disease (COPD), 20 with interstitial lung disease (ILD)). The mean difference in 6MWD between ambient air and SOT was 0 m (95% CI -14 to 13 m; p<0.001 for non-inferiority). Secondary outcomes demonstrated significantly lower dyspnoea scores with SOT both overall and within COPD/ILD subgroups. Patient preferences were split, with 49% favouring ambient air and 51% preferring SOT. A clinically meaningful improvement in 6MWD of >35 m was found in five patients.
In patients with CLD and exercise-induced desaturation, ambient air was non-inferior to pulsed low-dose SOT by portable concentrator in 6MWD, but SOT improved dyspnoea. These findings highlight the need for more effective, patient-acceptable oxygen delivery systems and further research to identify responders to SOT.
NCT06385301.

PMID:
42767802
Bibliographic data and abstract were imported from PubMed on 22 Sep 2026.

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