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 hard for the lungs to get the oxygen from the air into the blood.

In healthy lungs, as a breath is taken in, the oxygen is brought into the lungs and makes its way to the alveoli (al vee oh lie), or tiny air sacs in the lungs. These air sacs are surrounded by a network of tiny blood vessels, called capillaries. Two important things happen in this tiny space: 1) This is where the red blood cells pick up oxygen and 2) the red blood cells drop off the carbon dioxide carried back to the lungs from tissues and muscles in 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. Everybody has oxygen in their body, but some people don’t have enough. Oxygen therapy, or supplemental oxygen, helps make up for low oxygen levels. If it is needed, oxygen therapy is one of the most important ways to manage COPD symptoms in order to breathe better and stay well.

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 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.

What Happens When I Have a Low Oxygen Level?plus

When the oxygen level in the blood is low, it is called hypoxemia (hi-pock-see-mee-ah). Low oxygen levels can affect many parts of the 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 can become larger and weaker.
  • The 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 the brain. A person may find their ability to pay attention may be reduced. They may have memory and speech problems and may have trouble solving problems or doing more complex tasks.
  • Problems exercising. The ability to do physical activities may be reduced because the muscles in the legs and arms may become weaker.
  • Problems performing everyday tasks. Very low levels of oxygen in the blood can lead to confusion, coma, and even death.

How Do I Know if I Need Oxygen Therapy?plus

Shortness of breath is one of the first symptoms that may indicate a low oxygen level. Sometimes people think that they are short of breath because they are getting older, are out of shape or overweight, but understand that shortness of breath is not a symptom that should be swept aside as unimportant. If you are experiencing shortness of breath, tell your health care provider. Letting them know about your symptoms will help them determine the treatments and therapies you need. Once they know of your shortness of breath, they can choose one or more tests to decide if you need oxygen therapy.

The need for oxygen therapy may be determined 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 and you will be prescribed oxygen. After your infection has cleared and you are well again, you may not need long-term oxygen therapy so you should be checked again 1-3 months later.

What kind of tests measure oxygen in the body?plus

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

This test is the most accurate. In this test, blood is taken out of an artery in the arm, usually at the wrist. 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 but is quick and painless. There is no need for a blood sample, but only requires a small device to clip on the end of the 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 wearing a pulse oximeter to measure your oxygen saturation. If your oxygen saturation drops below a certain point during the test, it may indicate that you need oxygen therapy.

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

Your Oxygen Prescription

Oxygen is a medication. If the test results show that you need oxygen therapy, your health care provider (HCP) will write a prescription. To ensure you are provided with the right oxygen equipment for you, the prescription 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 and how often the supplies should be replaced.

Choosing an Oxygen Supplierplus

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. (In some areas, there is only one provider available.) 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.

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.

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 Systems and Devices

There are two types of oxygen systems: compressed gas and liquid.

Compressed Gas Oxygen

Compressed oxygen is delivered as a gas. It is odorless and colorless just like the air you breathe. This type of oxygen can be found in the following 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, while 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, how full the tank is, and liter flow. Portable tanks work well as backup for concentrators, but they are not good for continuous, long-term oxygen use.

One option to help oxygen supply last longer is to use an oxygen conserver. Using an oxygen conserver only releases oxygen when it senses a breath being taken. Conservers 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.

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.

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 oxygen 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.

Portable Oxygen Options

Portable Liquid Oxygen 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 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 Delivery Devices – 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. To prevent drying to the nasal passages, ask your oxygen supplier about adding a humidifier to your oxygen concentrator .

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.

For more information on supplemental oxygen download The Supplemental Oxygen Guide.

Tips for Safety

Take the following steps to ensure safety when bringing supplemental oxygen into your environment:

  • 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.
  • Consider using cotton bedclothes and sleeping garments to reduce risk of static electricity during sleep.
  • 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.

Will Medicare or My Health Insurance Cover Oxygen Therapy?plus

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.

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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.