Oxygen treatment for chronic obstructive pulmonary disease (COPD)

Treatment Overview

Oxygen treatment increases the amount of oxygen that flows into your lungs and bloodstream. If your COPD is very bad and your blood oxygen levels are low, getting more oxygen can help you breathe better and live longer.

There are several ways to deliver the oxygen, including:

• Oxygen concentrators.
• Oxygen-gas cylinders.
• Liquid-oxygen devices.

You don't have to stay at home or in a hospital to use oxygen. Oxygen systems are portable. You can use them while you do your daily tasks.

What To Expect After Treatment

Long-term oxygen treatment may improve your quality of life. It can help you live longer when 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 mostly to slow or prevent right-sided heart failure. It can help you live longer.

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 for at least 18 hours a day with as few interruptions as possible. Regular use can reduce the risk of death from low oxygen levels.¹ To get the most benefit from oxygen, you use it 24 hours a day.

An arterial blood gas test should be done first to see if you need oxygen. You may not be able to get Medicare reimbursement for home oxygen therapy without this test. If your test results 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 using oxygen at home for more than 15 hours a day increases quality of life and helps people live longer when they have severe COPD and low blood levels of oxygen.^{1, 2}

Using oxygen may also improve confusion and memory problems. It may improve impaired kidney function caused by low oxygen levels.

Risks

Generally, there are no risks from oxygen treatment as long as you follow your doctor's instructions. But oxygen is a fire hazard, so it is important to follow safety rules. Do not use oxygen around lit cigarettes, open flames, or anything flammable.

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 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 treatment very carefully because of the danger of fire or explosion.

You may need oxygen in certain situations, including:

• During exercise. For some people with COPD, blood oxygen levels drop only when they exercise or are very active. Using oxygen during exercise may help boost performance and reduce shortness of breath for some people. But there are no studies that show any long-term benefits from using oxygen during exercise.
• During sleep. During sleep, breathing naturally slows down 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 can really affect people with COPD. If you normally use oxygen or have borderline-low oxygen levels in your blood, you may need oxygen when you fly. Traveling with oxygen usually is possible. But it is important to plan ahead before you travel.

Complete the special treatment information form (PDF) (What is a PDF document?) to help you understand this treatment.

References

Citations

1. Kerstjens H, et al. (2005). Chronic obstructive pulmonary disease. Clinical Evidence (13): 1923-1947.

2. Barnes PJ (2000). Chronic obstructive pulmonary disease. New England Journal of Medicine, 343(4): 269-280.

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