Oxygen Therapy

Breathing is an involuntary process that gets oxygen into, and carbon dioxide out of, your lungs. The air sacs in your lungs (the alveoli) are where the oxygen we breathe enters our blood. Breathing is controlled by your brain, which regulates the rate (how often), depth and rhythm of your breathing based on your body’s needs at the time.

When you exert yourself by getting up and out of a chair, putting groceries away, or going up a hill or flight of stairs, your muscles require more oxygen. Your body responds by changing how you breathe so that you can get extra oxygen to the muscle cells that are demanding it. For most people, taking a short break allows them to get their breathing under control.

Many people who live with chronic lung disease have poor gas exchange in the alveoli of their lungs, which causes low blood oxygen level. Depending on your lung disease and its severity, low oxygen levels can occur when you are active, at rest, and/or during sleep. 

Your healthcare provider can assess your blood oxygen level by asking you to perform a walk test or sit-to-stand test during an office visit. Your blood oxygen level can be measured by an instrument called a pulse oximeter. An infrared light in the oximeter probe that is placed on your finger measures the blood oxygen saturation level, SPO2 (S= saturation, P=pulse, O2= oxygen). A blood test can also be used to measure blood oxygen level. This test is called an arterial blood gas (ABG). Pulse oximeter measures only oxygen saturation (SPO2) but ABG can measure blood level of both oxygen and carbon dioxide.

Not everyone who is short of breath has a low blood oxygen level. Oxygen therapy only benefits people with low blood oxygen levels. Proper assessment is the key. 

When blood oxygen levels are low, oxygen therapy helps your lungs, heart and muscles work more comfortably and effectively. Oxygen therapy can improve:

• functional activity
• mood or stress level
• energy level
• concentration

More benefits of oxygen therapy include improved sleep, faster recovery from illness and fewer hospital admissions.

Oxygen prescriptions 

Based on your disease severity and your needs, oxygen might be prescribed for you during specific times or continuously throughout the day and night. Your healthcare provider should assess your oxygen needs at rest and with exertion to determine if your oxygen needs. Chronic lung disease is treatable, but not curable. This means that as your disease progresses, your oxygen needs may change. It is very important to assess your blood oxygen level yearly, and to follow the oxygen delivery flow rates prescribed by your healthcare provider.

Oxygen prescriptions should be written to maintain a specific level of blood oxygen saturation, for example: oxygen setting of 2-4 lpm (liters per minute) to maintain oxygen saturation of greater than 90%.

Long-term oxygen therapy (LTOT) is oxygen therapy that is prescribed for at least 15 hours per day. LTOT increases survival and improves quality of life for people with COPD. It also improves quality of life for other lung diseases. LTOT can be delivered through different systems such as compressed oxygen gas cylinders, liquid oxygen or oxygen concentrators.

Compressed oxygen gas /liquid oxygen gas

Compressed oxygen gas /liquid oxygen gas offers non-stop oxygen flow while you inhale and exhale. It’s important to understand that when you get short of breath, for example when you exercise, your breaths become faster and shallower and you may not receive enough extra oxygen. This is why your healthcare provider may recommend that you increase your oxygen flow rate when exercising. Some people wonder why they need oxygen while they sleep – sometimes your blood oxygen level drops because of shallow breathing. Having a prescription for night time oxygen helps you feel better rested and clearer minded when you wake up. (This is different than sleep apnea)

Oxygen-conserving devices: Intermittent oxygen flow devices or pulsed-delivery devices

Special attachments or regulators can be used that deliver oxygen only when you inhale. These devices can deliver a big burst of oxygen when you first inhale then taper down until you exhale, or they can deliver a steady stream of oxygen only during the inhalation of your breath. These systems allow your oxygen delivery devices to last two to four times longer, which means that you can carry smaller devices. These devices are not for everyone. Your healthcare provider will know if this is the right device for you.

Stationary oxygen-delivery equipment 

Home oxygen concentrators work by filtering nitrogen out of the air in the room and concentrating the oxygen for delivery to you through your nasal cannula or oxygen mask. Home oxygen concentrators require a power source to operate. You will need a back-up source of oxygen in the event of a power outage. 

Freestanding oxygen cylinders or tanks should be considered as a back-up source of oxygen in the event of a power failure. It is very important that all oxygen cylinders or tanks be properly secured for your safety. 

Portable oxygen-delivery equipment

Portable oxygen concentrators are lightweight machines that can be carried outside of the home. These devices filter out the nitrogen from the air and concentrates the oxygen for delivery to you based on your prescribed flow rate. Portable concentrators have their own power source. Always carry an extra battery with you. 

Portable oxygen cylinders or tanks are smaller cylinders that can be used when leaving the home. This can be carried in a pack, or attached to a walker or wheelchair. Before leaving your home, check how much oxygen is in your tank.

Trans-fill oxygen concentrators or liquid oxygen systems can be used to refill your portable oxygen cylinders from home. Specific training and safety instructions are needed as these devices are tricky to use. Your home medical supply company is responsible for training you.

Supplies

• Nasal cannula, oxygen mask, foam ear pads
• Humidifier: humidification of oxygen delivered for LTOT makes breathing more comfortable and keeps delicate nose and lung tissue healthier. Only use distilled water in a humidifier

• Keep the contact information of your oxygen delivery company with your other important medical information.
• Plan before you go out. See how much oxygen is left in your tank. Check your battery life. Bring extra.
• Make sure your nasal cannula or mask is cleaned with warm soapy water 2 times a week. Replace your cannula every 2 to 4 weeks, or more often if needed.
• If your nose and lips become dry from oxygen use, use water-based lotions. Water-based lotions, moisturizers and lubricants have water as their first ingredient. Avoid products that contain petroleum jelly or oils.
• Saline nasal spray can give your nostrils some relief from dryness.
• Use gauze or foam pads behind your ears if the skin becomes raw. 

You can find out more about oxygen therapy in our Oxygen and COPD booklet.

Plan ahead at least four weeks before travelling.

Make sure you have these items together:

• A medical release from your provider stating that it is safe for you to travel.
• Your oxygen prescription that lists your flow rate and amount of oxygen you use. 

Flying with oxygen

Notify the airline about your oxygen usage and needs. There may be an extra charge if they are supplying you with supplemental oxygen. Know the make and model of your portable concentrator, the types of batteries you need and how to manage the alarms. If you need to bring extra tanks, ask the airline about their rules for packing tanks. Ask what to do if there is a layover, as you may need to arrange a supplier to come to the airport.

Going on a cruise with oxygen

Notify the cruise line about your oxygen usage and needs. You can usually take your own concentrator and tanks, though you will have to arrange for your oxygen to be delivered to the ship before departing. Make sure that you have enough oxygen for the entire cruise including ship time and shore time.

Taking a train or bus with oxygen

Notify the bus or train line that you will be travelling with oxygen. Some may have weight limits, but you can take your own tanks and concentrators. To refill tanks, make arrangements in the cities where your transportation stops. Always make sure to have back-up batteries and to be seated in a non-smoking car.