Oxygen Therapy

Everybody needs oxygen. Every tissue and cell in the body needs a constant supply of oxygen to work as it should. Chronic obstructive pulmonary disease (COPD) can damage your lungs. For some – but not all – people with COPD, it is hard for their lungs to get oxygen from the air into their blood.

Oxygen therapy can help. It is a medical treatment that is prescribed by a health care provider. For some people with COPD, oxygen therapy is an essential part of their treatment plan. If you have COPD you may, at some point, need oxygen therapy.

When talking about oxygen therapy, we sometimes use the words “supplemental oxygen.” Supplemental means to provide something in addition to what’s already there. Everybody has oxygen in their body, but some folks don’t have enough. Oxygen therapy, or supplemental oxygen, helps make up for low oxygen levels.

If you need it, oxygen therapy is one of the most important ways you can manage your COPD to breathe better and stay well.

How Do the Lungs Work?

Your lungs work by bringing in the “good air” and getting rid of the “bad air.” The oxygen you breathe in goes deep into your lungs and into tiny air sacs called alveoli (al-vee-oh-lie). These air sacs are surrounded by a network of tiny blood vessels.

This is where your red blood cells pick up oxygen and carry it to all parts of your body, including your tissues and muscles. This helps your body function. Carbon dioxide is a waste gas that is created when your tissues and muscles have used the oxygen. The carbon dioxide goes back to the network of vessels, out of the blood, and into the lungs where you breathe it out.

To learn more about how the lungs work visit our page on Understanding Your Lungs.

Oxygen therapy CAN make a difference in how you feel! If the oxygen in your blood is low, getting oxygen therapy can help you:

  • reduce your shortness of breath.
  • exercise longer and harder.
  • think and remember better.

What Happens When I Have a Low Oxygen Level?

When the oxygen level in your blood is low, it is called hypoxemia (hi-pock-see-mee-ah). Low oxygen levels can affect many parts of your body.

Low oxygen levels in the blood can cause:

  • The tubes of the lungs to become smaller. This can cause the heart to pump harder. Over time this strains the heart and as a result it canbecome larger and weaker.
  • Your body to make more red blood cells. Red blood cells carry oxygen through the body. By creating more red blood cells, the body is trying to deliver more oxygen. In some people this can cause blood clots, headaches, and high blood pressure.
  • Harm to your brain. Your ability to pay attention may be reduced. You may have memory and speech problems. You may have trouble solving problems and doing more complex tasks.
  • Problems exercising. Your ability to do physical activities may be reduced. Your muscles may become weaker.
  • Problems performing everyday tasks. Very low levels of oxygen in your blood can lead to confusion, coma, and even death.

How Do I Know if I Need Oxygen Therapy?

If you have shortness of breath or other symptoms that may indicate a low oxygen level, talk with your health care provider. He or she will choose one or more tests to decide if you need oxygen therapy.

Arterial (are-teer-ree-uhl) Blood Gas

This test is the most accurate. In this test, blood is taken out of an artery in your arm. Arteries carry blood that has picked up fresh oxygen from the lungs and has been pumped by the heart. This test measures the oxygen in your blood. It can also tell how well your lungs are getting rid of carbon dioxide.

Pulse Oximetry (ahk-sim-e-tree)

This test is less accurate. It is done without taking a blood sample. A pulse oximeter is a small device clipped to your finger. This clip shines a light through your blood and reports the percent of saturation of oxygen. Pulse oximetry cannot measure your actual blood oxygen, carbon dioxide level, or other elements in your blood. A pulse oximeter is easy to use and gives fast results, but should only be used following instructions from a respiratory health professional.

Walk Test

In this test, you walk while a pulse oximeter measures your oxygen saturation. If your oxygen saturation drops below a certain point during the test, it may indicate that you need oxygen therapy.

With an Exacerbation

The need for oxygen therapy may be seen during a hospital stay or during a visit with your health care professional. A lung infection or exacerbation (x-saa-cer-bay-shun) can cause oxygen levels to drop. If oxygen is needed during this time, it should be checked one to three months later. After your infection has cleared and you are well again, you may not need long-term oxygen therapy.

The results of these tests must always meet certain criteria in order for Medicare or your health insurer to pay for oxygen.

Your Oxygen Prescription

Oxygen is a medication. If your health care provider finds that you need oxygen therapy, he or she will write a prescription. This prescription will include dose and instructions for use. To ensure you are provided with the right oxygen equipment, the prescription your health care provider writes must include:

  • When to use oxygen. At rest? With exercise? While asleep?
  • Flow number (how many liters per minute).
  • How many hours a day oxygen should be used.
  • What specific equipment and supplies you should use andhow often the supplies should be replaced.

Choosing an Oxygen Supplier

When you get a prescription for oxygen, you will need to choose an oxygen supplier. If you’re prescribed oxygen at a health care provider’s office, someone on staff will show you a list of suppliers to choose from in your community. They will check with Medicare or your insurance provider to see if these payers have contracts with specific suppliers. If you don’t have insurance that covers the entire cost of your oxygen, ask the supplier if they have a patient assistance program.

After you have chosen a supplier, the person helping you will work with them to provide the documentation required in order for you to get started. Keep in mind that there may be only one supplier in your community.

If you’re a patient in the hospital and are told you need to start oxygen therapy, ask a medical social worker for help. He or she can tell you about your options before you commit to a supplier that will serve you at home.

It is important to choose the best one possible from the start. If you have Medicare, you have to stay with the supplier you choose for the first five years.

Asking the following questions should help you compare suppliers. Even if you don’t have a choice of suppliers, it is recommended that you ask these questions.

Basic information

  • Are you a national company?
  • Where is your nearest store located?
  • What systems do you provide? Why do you provide those systems?
  • What will this cost me?

Service at home

  • How often will there be an oxygen delivery to my home?
  • How often will equipment be checked or serviced?
  • Will you provide me with enough oxygen supplies to last and to avoid infection?
  • Will a health care professional come to check me in my home?

Getting out and traveling

  • Will I have an oxygen system that will allow me to get out and go places?
  • Will you help make plans for me to use oxygen if I decide to travel?

What if something goes wrong?

  • What is your response time in case of emergency?
  • How quickly do you replace broke equipment?
  • If I purchase (not rent), will you still provide service?

Customer feedback and credentials

  • Do you have customer feedback you can share?
  • Are you licensed and accredited? By which groups?
  • Have you been accredited by Medicare/Medicaid? Joint Commission on Accreditation of Health Organizations? (Both groups have standards that must be followed.)

Oxygen Modes and Systems

This section does not include images of specific oxygen equipment. To learn more, go to Resources on page 15 of the Oxygen Therapy SSRG available in our downloads library.

There are two oxygen modes: compressed gas and liquid.

Mode: Compressed Gas Oxygen

Compressed oxygen is delivered as a gas. It is odorless and colorless just like the air you breathe.

Systems: Cylinders, Tanks, and Stationary Concentrators

Portable tanks come in a variety of sizes and weigh between 0.7 and 7.9 pounds. Some regulators connected to a tank provide oxygen continuously. Others provide oxygen only when you breathe in. Smaller oxygen tanks are carried in tank bags that can be worn over the shoulder, backpack style, or carried by the handle. Larger tanks require a wheeled stand to transport safely. Other types of wheeled oxygen carriers allow you to take a spare tank wherever you go. These may be provided by the supplier or purchased online.

With a conserving device, compressed gas can last from one to five hours, depending on tank size and liter flow. Portable tanks work well as backup for concentrators but they are not good for continuous, long-term oxygen use.

Stationary tanks are large steel or aluminum tanks. They are very heavy and hard to move. They must be secured to prevent them from falling over. Large stationary tanks are good to have as backup to an oxygen concentrator if the power goes out. They are not good for someone needing continuous flow oxygen.

An oxygen concentrator works by removing nitrogen from room air to make oxygen. (“Room air” is a term for the air we all breathe here on earth. Room air is made up of mostly nitrogen, about 21% oxygen, and small amounts of some other gases.) An oxygen concentrator is about the size of a nightstand and weighs 22-70 pounds. It can have up to 50 feet of tubing. An oxygen concentrator must be placed in an open, ventilated area and have regular check-ups and filter changes done by the supplier.

An oxygen concentrator needs a source of electricity, so using it will probably cause an increase in your electric utility bill. Check with a medical social worker or local assistance program about help with this. You must have a source of backup oxygen in case of a power failure.

Mode: Liquid Oxygen

Liquid oxygen is stored in a large metal container in a cold, liquid form. This oxygen reservoir weighs about 124 pounds. It is filled by the supplier, usually twice a month depending on how much oxygen you need. As you fill your small portable device, the oxygen converts from a liquid to a gas.

The cost of supplying liquid oxygen is significantly higher than compressed gas systems. Due to this higher cost and limited reimbursement from Medicare, liquid oxygen is not available in many areas of the country.

Systems: Portables and Portable Oxygen Concentrators (POCs) range in size and weigh from 4 to 9 pounds and need to be filled each day. They have a wide range of continuous flow and conserving device settings. If you need higher flows of continuous oxygen, portable liquid systems may be the only option for helping you get out and about. No electricity is needed with a liquid oxygen system.

Note: With liquid oxygen, caution must be used to prevent spills. Liquid oxygen can injure the skin on contact.

Portable, battery-operated oxygen concentrators can be run using the battery provided, a car adapter, or by plugging it into an electrical outlet. Some portable oxygen concentrators can deliver both pulse and continuous flow. Some units are larger in size and have less battery capacity. It is recommended you have more than one battery for your device, keeping it charged at all times.

Note: The number settings on a POC do not indicate the same liter flow of oxygen as they do on other oxygen equipment. Before buying or leasing a POC, work with your health care professional to determine which POC can keep your oxygen at a level that is high enough for you.

Oxygen Conserving Devices or Pulse Dose

With an oxygen conserver, oxygen goes into you only when you breathe in. These units are usually lighter in weight and smaller in size and can last longer on the supplied battery.

They allow for longer periods away from home; however, they do not work for everyone because they do not deliver the high flows that some people need. When you breathe in using an oxygen conserver, those around you may hear a short clicking or hissing sound. Some newer units are very quiet.

Oxygen Delivery Systems – How Oxygen Gets into Your Lungs

In addition to choosing a type of oxygen mode and system, you will need to decide how oxygen will get from the system device into your body. There are four basic ways oxygen can be delivered to you. These are:

Nasal cannulas (can-you-luhs): Plastic tubing with one end connected to your oxygen source. On the other end are two small prongs that rest in your nose. The tubing stays in place by looping over your ears. A nasal cannula is simple to use and inexpensive. Oxygen through a cannula can be drying to the nasal passages.

Face masks: Plastic mask that fits snugly over the mouth and nose. It delivers a higher concentration of oxygen. It can make having a conversation difficult and it cannot be worn while eating and drinking. This is not a common option as it can make breathing feel restricted. Most people with COPD do not need this higher concentration of oxygen.

Oxygen reservoir cannulas: Oxygen reservoir cannulas have a pouch or a part of the tubing that is wider than the tubing itself. These devices hold a higher concentration of oxygen while you’re breathing out, so there is more oxygen available when you breathe in.

Transtracheal oxygen (TTO): A plastic tube surgically inserted through the skin of the neck into the windpipe or trachea (traykey-uh). With this, your required amount of oxygen can be delivered with a lower oxygen flow rate. The tube needs to be taken out and cleaned every day.

Will Medicare or My Health Insurance Cover Oxygen Therapy?

Home oxygen therapy and equipment is covered by Medicare Part B under “durable medical equipment.” If you have a Medicare Advantage policy, your oxygen will be covered by the insurance company providing that policy. Medicare pays a monthly amount for your main source of home oxygen. It typically covers 80% of oxygen equipment and supplies.

Check with a medical social worker, health insurance company representative, or other expert about how much your Medicare or health insurance policy will cover.

Your health care provider may prescribe a specific system for you, but this system may not be available in your area. You, your health care provider, and your oxygen provider will need to work together to solve this problem.

If you have Medicare and are unable to resolve the problem, you can contact Medicare to report the issue at 1-800-MEDICARE.

We encourage you to report your issue to us by emailing statecaptains@copdfoundation.org so we can continue to monitor ongoing oxygen access issues across the US.

Please vist Medicare Rules Governing Oxygen Therapy for more information

Tips for Safety

  • Keep oxygen canisters five to 10 feet away from gas stoves, fireplaces, woodstoves, candles, and other open flames.
  • Do not use electric razors, hair dryers, curling irons, etc. while using oxygen. Sparks and fire could occur.
  • Do not use oil, grease, or petroleum-based products on or near the equipment. Avoid petroleum-based lotions on your face or upper chest. Most pharmacies have water-based moisturizers.
  • Make sure there is NO SMOKING in your home, car, or anywhere close to you when oxygen is in use.
  • Always use the appropriate tank bag or cart for transporting your oxygen safely.
  • Secure oxygen tanks to fixed objects. If a tank is knocked over, the top could break off and the tank could become a missile.
  • Know the safety checks provided by your oxygen supplier. Keep important information (including emergency contact information) near a phone.
  • Be careful around oxygen tubing to avoid tripping.
  • Do not try to fix broken equipment yourself.
  • Have smoke detectors in your home. Make sure they are working. Check them monthly.
  • Keep a fire extinguisher in your home. Have an escape route planned in case of fire.
  • Let the fire department and gas, electric, and phone companies know when you start oxygen therapy. Ask to be designated as a “priority service listing.” This will help when there is a power or phone failure.

Can I Really Live My Life on Oxygen?

Finding out you need supplemental oxygen can cause you to feel frustrated, scared, and confused. You may feel that people will view you as “handicapped.” You might think it will be a hassle to be connected to an oxygen tank. You may think it will change all the plans you had.

If you are thinking or feeling this way, remember that oxygen therapy can help you feel less tired, less out of breath, and healthier. You may actually be able to do more than you could before. And it may help you live longer! Using supplemental oxygen, if required, is an important part of managing your COPD.

To learn more about Oxygen Therapy, check out Traveling with COPD.

Be sure to check out the Educational Materials Download Library to access more resources on oxygen, medications, nutrition, traveling with COPD, the Disaster Preparedness Plan and much more.

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Resources and Support

The COPD Foundation offers resources such as COPD360social, an online community where you can connect with patients, caregivers and health care providers and ask questions, share your experiences and receive and provide support. We also offer free, downloadable educational materials available through our downloads library.