Chronic Obstructive Lung Disease - Oxygen-Replacement Therapy

Oxygen-Replacement Therapy

Lung function may eventually worsen to the point that patients may need supplemental oxygen delivered 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. Continuous oxygen therapy is usually recommended for patients with:

• Lung oxygen level below 55 mm Hg while resting
• Lung oxygen level below 60 mm Hg while resting, plus right heart failure or an abnormal increase in red blood cells

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Ideally, the patient should receive enough oxygen to keep the oxygen level at 65 mm HG, but no less than 60 mm HG, or at an oxygen saturation level of at least 90%. Patients may need extra oxygen flow during sleep or physical activity.

About 40% of patients improve enough in 1 month to stop continuous treatment, although these patients should be observed closely. COPD often gets worse, and patients need to restart oxygen therapy. Some patients get worse in spite of treatment, although it is not possible to predict who is at risk for oxygen therapy failure. The addition of nitric oxide, a gas that widens blood vessels, may offer additional benefits.

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

• Patients whose oxygen level drops below 55 mm HG only while exercising may benefit from supplemental oxygen during physical activity. Supplemental oxygen may improve endurance, and it enhances the delivery of oxygen to the muscles while they are working.
• Patients whose oxygen level drops below 55 mm HG during sleep may need oxygen at night. Such patients usually experience fitful, poor-quality sleep. This type of oxygen therapy does not appear to affect survival or prolong the time until patients need continuous oxygen therapy.

Oxygen During Travel. People on continuous oxygen therapy who are traveling by plane should increase their oxygen by 1 - 2 liters per minute during the trip. People on intermittent oxygen therapy may need oxygen during air travel if the trip is longer than 2 hours and they develop symptoms, or if they experience a drop in oxygen levels before traveling. People are not allowed to bring their own oxygen tanks on board an airplane; many airlines will provide oxygen if notified 48 - 72 hours in advance. It is important to note that aircraft cabins are pressurized to the equivalent of 8,000 feet above sea level. Such pressures could be potentially dangerous for people with severe COPD.