Your Doctor Has Prescribed Supplemental Oxygen—Now What?

It’s difficult news to hear from a doctor, though not uncommon for people with COPD: You need supplemental oxygen.

COPD—chronic obstructive pulmonary disease—is emphysema and/or chronic bronchitis with an obstructed airway. The obstruction is caused by thickening airways, greater mucus in the airways, or the destruction of the tiny air sacs, making the lungs less elastic. COPD makes it hard to breathe, and as a result, hard to get enough oxygen into your bloodstream.

Supplemental oxygen gives you an extra boost, but it requires being tethered to an oxygen source. The source may be stationary or portable. It is delivered from a tank or concentrator to your nose via a small hose with tiny buds that fit into your nostrils (called a nasal cannula) or through a mask.

“It causes a huge lifestyle change,” says UNC Health pulmonologist Ashley Henderson, MD. “Often people will worry that they will look funny in public or that they will be judged as old or sick.”

But with more than 1.5 million adults in the United States using supplemental oxygen, the sight of someone wearing a nasal cannula or mask is not uncommon. And the improvement to quality of life can be significant. That’s why Dr. Henderson reminds patients to focus on the benefits of receiving supplemental oxygen.

“You’ll feel better,” she says. “You’ll have more energy and endurance.”

Read on for commonly asked questions about supplemental oxygen.

When does a patient need oxygen?

Your doctor will use a device called a pulse oximeter to measure how much oxygen is in your blood. Usually, the device is clipped to your finger, but sometimes it is placed on a toe or earlobe. It uses light beams to measure your oxygen levels. Oxygen is critical for building new cells, producing energy and supporting our immune system.

Blood oxygen levels in healthy people are usually 96 or 97 percent. People with lung diseases may have about a 92 percent level and still function reasonably well. A reading of 88 percent or lower generally means that supplemental oxygen is needed.

Personal oxygen saturation monitors are available, but Dr. Henderson cautions that they may not give reliable measurements if a person has an irregular heartbeat or poor circulation in their fingers. It’s best to get your blood oxygen measured by a doctor.

What are signs of low blood oxygen levels?

If your blood oxygen levels are too low, you may experience:

  • Shortness of breath
  • Tightness or pain in the chest
  • A bluish tint to nails, fingertips or lips (usually, a family member or caregiver notices this sign)

If you have these symptoms, you should talk to your doctor, but don’t assume you do or don’t need oxygen.

“This can be hard because some patients who have shortness of breath still don’t need oxygen,” Dr. Henderson says, “and some who need oxygen think they are breathing fine.”

Whether you need oxygen or not, these symptoms should be assessed by a doctor who can figure out what’s going on and get you the treatment you need.

How do you get supplemental oxygen?

Most insurance policies and Medicare cover supplemental oxygen if you have a prescription from your doctor. Oxygen may not be available at all without a prescription or may be very expensive.

Supplemental oxygen can be delivered in a variety of ways. The most common methods are tanks (or cylinders) of oxygen and oxygen concentrators. Both tanks and concentrators can be either stationary or portable.

A tank of oxygen contains either compressed oxygen gas or, less frequently, liquid oxygen. The tanks come in different sizes: some very large and not intended to be moved, some small enough to pull around on wheels, and some small and light enough to carry in a bag or pouch.

Your doctor will prescribe how much supplemental oxygen you need, measured by liters per minute. Your tank will have a flow regulator that is set to release the amount of oxygen you need. The regulators may deliver oxygen by continuous flow or pulse-dose flow, which means short bursts of oxygen are released only when you inhale.

Oxygen supply companies will deliver tanks of oxygen to you on a regular basis.

A popular alternative to oxygen tanks is the oxygen concentrator. The air around us is usually about 21 percent oxygen and 79 percent nitrogen (plus trace amounts of a few other gases). Oxygen concentrators pull oxygen out of the air for the patient. Concentrators vary in size, weight, oxygen flow settings and battery life. Generally, they are more expensive upfront than tanks, but some people find them more convenient. Over time, the costs may be similar.

How much will your life change when you start using supplemental oxygen?

Whether supplemental oxygen changes your life for the better depends on you, Dr. Henderson says. Learning to live with it isn’t always easy, but adjustments can be made to keep you active.

“In an ideal world, everyone who needs oxygen would have a portable tank or portable concentrator,” she says. “People need to keep moving.”

Stationary devices sometimes come with very long hoses that allow people to move about their home, but they can pose a tripping hazard. Carrying a portable device allows more mobility but comes with its own challenges.

Dr. Henderson reminds her patients that some changes are positive. Supplemental oxygen gives patients more energy and endurance and helps them feel better overall.

“Don’t let your need for oxygen hinder you,” she says. “Keep doing things. Stay mobile.”

What could happen if you need supplemental oxygen and don’t use it?

Not using oxygen as prescribed can leave you short of breath or struggling to breathe. You may feel weak. And the lack of oxygen can put a significant strain on your heart, leading to permanent damage.

“Maybe if you are elderly and fairly immobile, (supplemental oxygen) might not be worth it to you,” Dr. Henderson says. “But if you’re younger or more active and have significant COPD, we will push you to stay on your oxygen to avoid additional problems that might develop.”

Another important note: Don’t ever smoke while you are on oxygen. Smoking is by far the leading cause of COPD in the United States, Dr. Henderson says. And some people can’t stop, even when they are on oxygen, which is highly flammable. If you smoke while on oxygen, the risk is great that the oxygen will literally blow up in your face.

“The burn unit here (at UNC Health) regularly has patients who tried to smoke while on oxygen,” she says.

Talk to your doctor about cessation methods to avoid serious injuries and take care of your lungs.

If you have difficulty breathing or tightness in your chest or you have been diagnosed with COPD and your symptoms are getting worse, talk to your doctor. Find a doctor near you.