COPD News TodayOxygen Manifesto, Part 1: Advice from 3 Respiratory Specialists

Uncover vital insights about supplemental oxygen use, demystify misconceptions, and learn best practices for managing respiratory diseases.

Good day, physicians. Let’s talk about the controversial issue of supplemental oxygen use, frequently discussed by patients, clinicians, advocacy groups, and even politicians. In this summary, we’ll untangle misconceptions and illuminate best practices.

To start with, the body’s oxygen utilization depends on three things: lung function, heart efficiency, and muscle oxygen use. These factors can improve with exercise, but worsen with inactivity. Remember, exercise matters.

Why does oxygen matter? For patients with chronic obstructive pulmonary disease (COPD), pulmonary fibrosis (PF), or pulmonary hypertension (PH), impaired oxygenation can lead to hypoxemia and hypoxia. Hence, supplemental oxygen becomes a necessity.

How do we assess oxygen levels? Two tests can be employed: arterial blood gas (ABG) or pulse oximetry. Normal partial pressure of oxygen, as per ABG, is around 75-100 mmHg, and a drop below 60 necessitates supplemental oxygen. Oxygen saturation, measurable via either test, should ideally be 95% or above, and values dropping to 90 or below indicate the need for supplemental oxygen.

Now, let’s dispel some myths. Shortness of breath doesn’t always equate to hypoxia. A patient can experience breathlessness even with normal oxygen saturation. If saturation is normal, additional oxygen won’t help.

What to do if breathless but oxygen is fine? First, stop the activity causing breathlessness. Adopt recovery positions, employ controlled breathing techniques, reassess the situation, and continue the activity using modified techniques.

Conversely, hypoxia may occur even if breathlessness isn’t evident. In such cases, supplemental oxygen is vital, as hypoxia can lead to coronary insufficiency, arrhythmia, pulmonary hypertension, and heart failure.

Hence, rely on your instruments for oxygen measurement, not just feelings. Regular oxygen measurement, both at rest and during activity, is necessary until a patient understands their body’s oxygen needs.

Debunking some misconceptions: oxygen use shouldn’t be limited to the home or avoided during short dips in saturation. Oxygen can’t be stored for later, and its absence can have severe health consequences. Concerns about “too much oxygen” leading to cessation of breathing in “CO2 retainers” are generally unfounded. Optimal oxygen saturation is about 93 percent or more during activity.

Stay tuned for the next part of the series discussing supplemental oxygen delivery devices, accessories, and best practices.