The Confusing World of Long-Term Oxygen Therapy

This post was written by Michael W. Hess, MPH, RRT, RPFT with guest authors Jean Rommes, PhD and David Reynolds, RRT, EMT.

Inside the hospital, oxygen therapy can seem pretty easy. There is an endless stream that comes out of the wall, or as many tanks as you need to move around. Outside the hospital, it gets more complicated. This is especially true when it comes to trying to figure out what portable oxygen system fits your needs best. To help cut through some of the confusion, we asked a couple of experts to share their thoughts on how to choose the best portable oxygen system for your lifestyle. Jean Rommes is an oxygen therapy user and longtime patient advocate. Dave Reynolds is a respiratory therapist and emergency medical technician with over 25 years of experience as a durable medical equipment (DME) supplier. Together, we hope to help answer some of the most common questions about oxygen therapy.


The first thing to figure out is if oxygen therapy can help you. Dave points out that to qualify, either your pulmonologist or primary care provider (PCP) must order a test that measures the oxygen level in your blood. This is sometimes done with a special lab test called an arterial blood gas sample, or ABG. Most commonly this is done by using a device called a pulse oximeter on your finger or ear. If your oxygen level is below a certain level (usually 88%), oxygen therapy might help. Jean points out that it is important that you do things like what you do in your daily routine when you are being tested. You will be tested while you are at rest, but your oxygen level should also be checked with low activity (as Jean describes it, “strolling through the mall”), harder exercise (“walking at a good steady clip”), and then your maximum level, like climbing stairs. You may need to change your oxygen settings depending on how hard you are working.


Those settings may also affect the kind of portable oxygen system you need. The two main kinds of portable oxygen equipment are compressed gas cylinders (often called tanks) and portable oxygen concentrators (POCs). Both types have pros and cons. For example, many POCs use what is called “pulse dose” delivery. Instead of a constant flow of oxygen, a puff of oxygen is delivered as you start to inhale. That may not be enough for you, especially if you are exercising hard. Jean has used both but prefers using a tank while exercising for exactly that reason. “If the POC won't meet your O2 needs, then anything that will is better,” she says. Dave reminds us that POCs are also electronic devices that can fail unexpectedly. Oxygen tanks can be quite heavy, so you may need a backpack or a small cart to move them around. It is important to work with your care team and your oxygen equipment supplier to review the options. You may be able to do a “test drive” with different equipment to see what works best for your lifestyle.


It is also important to be aware of potential problems before they happen. For one, there are some safety concerns to keep in mind. Dave tells us, “Portable medical oxygen tanks and oxygen concentrators add to an increased risk for fire in the home.” This is because oxygen can make fires burn hotter and faster than they normally would, which means things could get out of hand quickly. There is also an increased risk of falls, so people must be careful to not trip over their oxygen tubing.

According to Jean, it can be a big change in someone's lifestyle. Sometimes people do not want to wear their oxygen outside their homes. They may not want their friends to know they need it. Some are worried that they may become addicted to it somehow. However, Jean reminds us that “people need to understand that it's critical to their health to have good O2 sats.” That means it is very important to use your oxygen therapy as prescribed and to discuss concerns with your care team.


Both Jean and Dave were quick to point out that oxygen equipment suppliers are feeling the pinch of increasing costs and decreasing insurance payments. “Oxygen in the hospital seems to be in an unending supply,” Dave tells us. Oxygen in the home is an entirely different business. Jean agrees and feels many people do not get enough education about it. “It’s rare to find [an oxygen supplier] that still has a respiratory therapist on staff who understands oxygen,” she says. That means people new to oxygen therapy are often trained by the delivery drivers. As nice as they are, Jean says, they generally do not understand what oxygen therapy is supposed to do. People must speak up for themselves when they have questions, and they should never be afraid to “insist on fair treatment” and remember that there are resources like the Medicare support line (1-800-MEDICARE) if they do not receive it.

Hopefully, this sheds more light on some concerns you may have about oxygen therapy. If you have more questions, we are here to help! Check out our newly-revised Oxygen Therapy Basics booklet for a more detailed look at oxygen therapy, or join us for our monthly OxyTalk virtual coffee hour. Breathe easy!


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  • Very well presented. Thank you.
  • My dad is 84, and End of Stage COPD. After a recent hospital stay for pneumonia, was transferred to Rehab facility. They used an oxygen concentrator similar to his home unit. My question is this…At home the unit is on “5”. At rehab was on 2-3, in 4 only a couple times. Why can he breath with the lower amount there but not at home? I’m baffled.
    • When the 02 was prescribed, the doc responsible indicated the appropriate setting in the prescription; whether anyone paid any attention to it is always questionable. Different situations require different settings: you need less when you're sitting and watching TV and more when you're going to the bathroom or cooking a meal. It's probably likely that the 02 readings were monitored in rehab based on oximeter readings taken by the staff. They probably suggested that it be on 5 all the time so he gets plenty when he's up and moving. To really do it correctly, he needs an oximeter and he should use it. You always want it to show at least 88 and most docs prefer 90, and more is better.
  • One thing I just recently started doing this month is taping my mouth closed at bedtime as D and H say I snore. With my mouth taped shut (just a tiny piece of tape), I no longer snore. I figure if I’m snoring and my mouth is open, I’m not benefitting much for my nighttime supplemental O2.