Oxygen-Replacement Therapy

Eventually, lung function may worsen to the point that some patients may need to rely on supplemental oxygen provided through portable or stationary tanks.

Continuous Therapy. Continuous oxygen therapy (more than 15 hours a day) is the only treatment for emphysema that has been proven to prolong survival in certain patients. It also improves alertness, motor speed, and hand strength. Usually continuous oxygen therapy is recommended for patients under the following circumstances:

• If the lung oxygen level (measured as arterial blood gas PO2) is below 55 mm/Hg while the patient is resting.
• If the resting PO2 is less than 60 mm/Hg and the patient has right heart failure or an abnormal increase in red blood cells (polycythemia).

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The patient should receive enough oxygen to keep the PO2 ideally at 65 but no less than 60 mm/Hg, or as blood tests show an oxygen saturation of at least 90%. An additional liter per minute of oxygen flow may be needed during sleep or exertion.

About 40% of patients improve enough in one month to stop continuous treatment, although such patients should be observed closely. COLD frequently deteriorates, requiring reinstitution of oxygen therapy. Some patients worsen in spite of treatment, although at this point it is not possible to predict who is at risk for oxygen therapy failure. The addition of nitric oxide may prove to offer additional benefits.

Noncontinuous Oxygen. Patients with less severe COLD who are not on permanent oxygen maintenance may need supplemental oxygen during specific circumstances:

• Patients whose PO2 drops below 55 mm/Hg only while exercising may benefit from supplemental oxygen during physical activity. Supplemental oxygen does not necessarily improve exercise performance, but it does enhance delivery of oxygen to the muscles while they are working.
• Oxygen may be needed at night (nocturnal oxygen) for patients whose PO2 drops below 55 mm/Hg during sleep. Such patients usually experience fitful, poor-quality sleep. Such oxygen therapy does not appear to affect survival or to delay prescription of continuous oxygen therapy.

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