Treatment Overview

Oxygen treatment increases the amount of oxygen that flows into the lungs and into the bloodstream, may improve shortness of breath, and prolongs survival of some people who have severe chronic obstructive pulmonary disease (COPD).

Oxygen treatment may be given using several delivery systems, including air concentrators, oxygen-gas cylinders, and liquid-oxygen devices.

You do not have to stay at home or in a hospital to use oxygen; oxygen treatment systems are portable and can be used while doing daily tasks.

What To Expect After Treatment

Long-term oxygen treatment may improve your quality of life. It reduces the risk of death if you have severe COPD and low oxygen levels. You may notice less shortness of breath and have more energy.

Why It Is Done

Long-term oxygen therapy is used for COPD if you have low levels of oxygen in your blood (hypoxia). It is used primarily to prevent or slow the progression of right-sided heart failure and to prevent premature death. Oxygen may be given in a hospital if you have a rapid, sometimes sudden, increased shortness of breath (COPD exacerbation) or at home if your blood is too low in oxygen for long periods.

Long-term oxygen therapy should be provided 24 hours a day for full benefit and at least 15 hours a day to lower the risk of premature death. In cases of severe COPD, it should be used continuously for at least 18 hours a day to reduce the risk of death.¹

An initial arterial blood gases test should be done to determine whether you need oxygen and may be required to satisfy Medicare requirements for reimbursement if home oxygen therapy is used. If you do not meet the following guidelines, Medicare may not pay for home oxygen therapy:

• Arterial oxygen pressure is less than or equal to 55 mm Hg (millimeters of mercury, a measure of pressure).
• Arterial oxygen saturation is less than or equal to 88%.
• Arterial oxygen pressure is between 56 mm Hg and 59 mm Hg or oxygen saturation is 89% and you have:
  • Evidence of right-side heart failure due to breathing problems (cor pulmonale).
  • Heart failure.
  • An increased number of red blood cells (erythrocytosis).
• Arterial oxygen saturation is greater than 88% when you are resting but becomes less than or equal to 88% when you are exercising or sleeping.

How Well It Works

Several studies show that long-term treatment (more than 15 hours a day) with oxygen at home increases quality of life and reduces the risk of death for people with severe COPD.^{1, 2} There is no evidence that shows oxygen reduces the risk of death of people who have low oxygen levels only during exercise or during sleep.

Oxygen therapy may also improve confusion and memory problems and impaired kidney function due to low oxygen levels in the blood.

Risks

Generally, there are no adverse effects from oxygen treatment.

The oxygen flow rate should not be set too high; generally, the arterial oxygen pressure is 60 mm Hg to 65 mm Hg, or the oxygen saturation is 90%. Higher flow rates usually do not help and can increase the risk that you will breathe too slowly, allowing too much carbon dioxide to build up in your blood.

What To Think About

People who continue to smoke may not benefit much from oxygen therapy.

There is a high risk of fire or explosion if you use oxygen around lit cigarettes or an open flame. If you or those who care for you smoke, oxygen therapy may not be a good option because of this.

You may need oxygen in certain situations, including:

• During exercise. Some people with COPD have their blood oxygen levels dip only during exercise or exertion. Using oxygen during exercise may help boost performance and reduce shortness of breath for some people. There are no studies, however, that have shown any long-term benefits from oxygen therapy use during exercise.
• During sleep. During sleep, respiratory function naturally declines because the body doesn't need as much oxygen. Sleep-related breathing disorders are quite common in people with COPD, and many will have significantly low blood oxygen levels during sleep.
• For air travel. The level of oxygen in airplanes is about the same as the oxygen level at an elevation of 8000ft(2438.4m). This drop in oxygen level can have significant effects on people with COPD. If you normally use oxygen or have borderline-low oxygen levels in your blood, you may require oxygen while flying. You are not allowed to bring your own oxygen on board airplanes and must call the airline company to arrange for oxygen.

References

Citations

1. Kerstjens H, Postma D (2003). Chronic obstructive pulmonary disease. Clinical Evidence (9): 1645–1663.
2. Barnes PJ (2000). Chronic obstructive pulmonary disease. New England Journal of Medicine, 343(4): 269–280.

Credits

Medical review	Author	Last updated
Renée M. Crichlow, MD - Family Medicine	Robin Parks, MS	July 27, 2004

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