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, making it harder for the lungs to get the oxygen from the air into your blood.

In healthy lungs, oxygen is inhaled into the lungs and makes its way to the alveoli, or tiny air sacs in the lungs. These air sacs are surrounded by tiny blood vessels, called capillaries. As blood flows through, red blood cells pick up oxygen and drop off carbon dioxide. COPD can disrupt this process, causing the lungs to need help providing enough oxygen to the rest of the body. If this process has been disrupted by COPD, the lungs may need some help providing enough oxygen to the body. If this is the case, oxygen therapy may be needed.

Oxygen therapy is a medical treatment that is prescribed by a health care provider. You may hear this treatment referred to as "supplemental oxygen". Supplemental means to provide something in addition to what’s already there. With supplemental oxygen, you will get the extra oxygen your body needs. For people with low oxygen levels, supplemental oxygen therapy is one of the most important ways to manage COPD symptoms, breathe better, and stay well.

Finding out you need supplemental oxygen can cause you to feel frustrated, scared, and confused. You may feel people will view you differently. You may think it will be a hassle to be connected to an oxygen tank. You may think it will change all the plans you have made for your future. If you are thinking or feeling this way, remember that oxygen therapy can help you feel less tired, less out of breath, and healthier in general. You may be able to do more than you could before. It may also help you live longer.

How Do I Know If I Need Oxygen Therapy?plus

Shortness of breath is often one of the first symptoms that may indicate a low oxygen level. Being short of breath can be related to other things, but it should NEVER be swept aside as unimportant. If you are often short of breath, tell your health care professional. Letting them know about your symptoms will help them determine the best therapy plan for you. They can test your oxygen levels to see if oxygen therapy might help.

What Tests Measure Oxygen Levels?plus

Arterial Blood Gas (ABG) sample

This is the most accurate way to measure the oxygen and carbon dioxide in your blood. A small amount of blood is taken from an artery in your wrist or arm. Arteries carry blood that has picked up fresh oxygen from the lungs and has been pumped to the body by the heart. This test measures how much oxygen is being carried. It can also measure how well your lungs are getting rid of carbon dioxide.

Pulse Oximetry

This test is somewhat less accurate than an arterial blood gas but is quick and pain-free. A device clips on the end of your finger or on your earlobe. It shines a light through your skin and blood and measures how many red blood cells are carrying oxygen. A pulse oximeter is easy to use and gives fast results, but can be affected by poor circulation, nail polish, or skin tone. It should only be used following instructions from your health care professional.

What Happens When I Have a Low Oxygen Level?plus

When the oxygen level in the blood is below normal, it is called hypoxemia. Hypoxemia can affect many of your organs and tissues. Low oxygen levels can cause:

  • Your heart to pump harder. Over time, this puts a lot of strain on the heart, causing it to become larger and weaker.
  • Your body to make more red blood cells. Red blood cells carry oxygen through the body. By making more red blood cells, your body is trying to deliver more oxygen to your organs. In some people, this can cause blood clots, headaches, and high blood pressure.
  • Problems with thinking. You may have trouble paying attention. You may have memory or speech problems or experience more difficulty solving problems or doing tasks. In severe cases, very low oxygen levels can cause confusion, coma, and even death.
  • Problems with exercise. Your ability to do physical activities may be lower because your muscles may become weaker and your energy level may drop.

Your Oxygen Prescription

Oxygen is considered a medication. If your test results show that oxygen therapy may help, your health care professional will write a prescription. To make sure you are given the right oxygen equipment, the prescription must include:

  • When to use oxygen therapy (at rest, during sleep, or continuously).
  • Flow rate (in liters per minute).
  • Specific equipment or supplies (for example, a portable oxygen concentrator).

Choosing Your Oxygen Supplierplus

When you get your prescription for oxygen, you will need to choose an equipment supplier. Your health care professional should be able to provide you with a list of suppliers in your community to choose from. In some areas, there is only one provider available. They may also check with Medicare or your insurance company to see if your payer has a contract with a specific supplier. If you do not have insurance that covers the cost of your oxygen, you may ask the supplier if they have a patient assistance program.

If you are able to compare suppliers, consider asking them these questions:

  • Are you a national company?
  • What types of equipment do you provide?
  • Can the equipment allow me to go out and travel?
  • What will this cost?
  • How often will oxygen supplies be delivered?
  • How often will my equipment be checked or serviced?
  • Will a health care professional come to check on me in my home?
  • What is your response time in case of emergency?
  • How quickly will you replace broken equipment?
  • Are you accredited by any organizations?
  • Do you have customer feedback you can share?

Oxygen therapy equipment is covered by Medicare Part B as durable medical equipment. Medicare pays a monthly amount for your oxygen. It typically covers 80% of the cost of equipment and supplies. If you have a Medicare Advantage policy, your oxygen equipment will be covered by the insurance company providing that policy. Other insurance companies may pay a different amount. Check with a medical social worker, health insurance representative, or other expert about how much your specific policy will cover.

If you have Medicare and are unable to resolve a problem locally, you can contact Medicare directly at 1-800-MEDICARE to report it and get help. We also encourage you to let us know by emailing oxygen360@copdfoundation.org so we can continue to monitor oxygen access across the United States.

Oxygen Systems and Devices

There are different kinds of equipment that can be used to deliver oxygen therapy. For more details on each type, read our Oxygen Therapy Basics publication.

Stationary Concentrators

These work by removing nitrogen from the air around you to create high levels of oxygen. Air usually contains 21% oxygen, but these machines can concentrate those levels close to 100%. A stationary concentrator is about the size of a nightstand and weighs 22-70 pounds. It must be placed in an open, well-ventilated space and should have regular checks from your supplier. It needs a continuous source of electricity, so it may cause an increase in your utility bill. Local assistance programs may be able to help you with this cost. You should have a backup source of oxygen in case of power outages.

Portable Concentrators

These are similar to stationary concentrators but are smaller and lighter. They can run on batteries or car adapters. Because they are smaller, the amount of oxygen they generate is lower. They often deliver a “pulse” of oxygen instead of a continuous flow in order to conserve the gas. That means the settings on a portable concentrator are NOT the same as a liter flow setting. Before buying or leasing a portable concentrator, work with your supplier and health care professional to determine if a portable concentrator can keep your oxygen levels high enough.

Oxygen Tanks

These are aluminum or steel tanks that are filled with compressed oxygen gas. They come in a variety of sizes, from small ones that are carried in a shoulder bag to large ones that are secured in place for a backup source of oxygen. They can be fitted with regulators that provide either continuous flow or pulse delivery, depending on your needs.

Liquid Oxygen

Liquid oxygen systems used very high pressures and cold temperatures to store large amounts of oxygen. The advantages of these systems were that they did not need electricity and could last several hours between refills. However, they were expensive to service and many companies stopped supplying them. Liquid oxygen is no longer available in most areas of the United States.

Oxygen Delivery Devices - How Oxygen Gets into Your Lungs

Regardless of the system you use, you must have a way for the oxygen to get from the equipment into your lungs. For most people, this will be a nasal cannula. This is a small rubber tube that sits under your nose, with two prongs that rest inside your nose. The tubing loops over your ears to stay in place and connects to your oxygen equipment. Some cannulas have a section that is wider so they can hold a higher concentration of oxygen while you are breathing out. That makes more oxygen available for when you breathe in. Some people also use small humidifiers connected to the oxygen tubing to prevent the nasal passages from drying out.

Oxygen Safety Tips

  • DO NOT SMOKE WHILE ON OXYGEN THERAPY! Be sure there is NO SMOKING in your home, car, or anywhere close to you when oxygen is in use.
  • Keep oxygen equipment five to 10 feet away from gas stoves, fireplaces, woodstoves, candles, and other open flames.
  • Do not use hair dryers, curling irons, or other electric tools while using oxygen. Sparks and fire could occur.
  • Consider using cotton bedclothes and sleeping garments to reduce risk of static electricity during sleep.
  • Do not use oil- 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.
  • 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.

The COPD Foundation has launched the Oxygen360 initiative to improve many aspects of oxygen therapy. We have also designated October 2 as World Oxygen Day, an annual advocacy and educational event to help people understand more about life with oxygen therapy.

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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.