Oxygen treatment for chronic obstructive pulmonary disease (COPD)

Treatment Overview

Oxygen treatment increases the amount of oxygen that flows into the lungs and into the bloodstream. Increased oxygen can improve shortness of breath and prolong survival of some people who have severe chronic obstructive pulmonary disease (COPD) and low blood oxygen levels.

Oxygen treatment may be given using several delivery systems, including oxygen 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). Oxygen can also be used at home if the oxygen level in your blood is too low for long periods.

Long-term oxygen therapy should be used as continuously as possible and for at least 18 hours a day. Regular use can reduce the risk of death from low oxygen levels.¹ To get the most benefit from oxygen, it should be used 24 hours a day.

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 partial pressure of oxygen (PaO₂) 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 partial pressure of oxygen (PaO₂) 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}

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. But oxygen is a fire hazard. It is important to follow safety measures to keep you and your family safe. Do not use oxygen around lit cigarettes, open flames, or flammable substances.

Oxygen is usually prescribed to raise the PaO₂ to between 60 and 65 mm Hg or the saturations from 90% to 92%. Higher flow rates usually do not help, and they can even be dangerous.

What To Think About

People using oxygen therapy should not smoke.

Do not use oxygen around lit cigarettes or an open flame. If you or those who care for you smoke, or if there are other risks for fire, it is important to consider oxygen therapy very carefully because of the danger of fire or explosion.

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 8000 ft (2438.4 m). 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. Traveling with oxygen usually is possible. But it is important to plan ahead before you travel.

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Author:	Lila Havens Robin Parks, MS	Last Updated June 16, 2006
Medical Review:	Renée M. Crichlow, MD - Family Medicine Kathleen Romito, MD - Family Medicine Ken Y. Yoneda, MD - Pulmonology
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