Overview of Home Oxygen Therapy
For people living with long-term lung or heart diseases, they may need to keep using oxygen treatment even after they leave the hospital. Using oxygen at home can be very helpful when it is used correctly.
There are several ways oxygen can be given at home:
– Long-term oxygen therapy (LTOT): This kind of oxygen treatment is for patients with chronic low oxygen levels in their blood. The oxygen is usually given for at least 15 hours a day.
– Ambulatory oxygen therapy (AOT): This type of therapy gives oxygen during physical activities and day-to-day tasks. It’s for patients who do not have low oxygen levels when resting, but do when they are active.
– Nocturnal oxygen therapy (NOT): With this method, oxygen is given only during the night. There is no oxygen treatment during the day.
– Short burst oxygen: This method lets patients use oxygen for short periods of time when they need it, even if they don’t have low oxygen levels.
– Palliative oxygen therapy (POT): This method is for relief of difficult breathing in patients living with severe or terminal diseases, even if they do not have low oxygen levels.
Each of these ways to give oxygen at home has varying levels of scientific evidence to support how well it works.
Why do People Need Home Oxygen Therapy
Long-term oxygen therapy (LTOT) can be useful for certain medical conditions. It involves using oxygen for longer periods to ease symptoms and manage certain diseases. Oxygen therapy can help in the treatment of these main categories of diseases:
1. Chronic Obstructive Pulmonary Disease (COPD):
This is a lung disease that makes it difficult to breathe and causes a person to feel constantly out of breath. Oxygen therapy is suggested for people with COPD in the following situations:
- When the oxygen levels in the blood at rest drop significantly,
- When oxygen levels drop slightly but there are other issues such as damage to the right side of the heart or an excess of red blood cells (a condition known as polycythemia).
The treatment has been found to increase life expectancy in patients with COPD, who are not receiving enough oxygen (a condition referred to as chronic hypoxemia). Also, it may improve factors other than just life expectancy, including mood, thought processes, ability to exercise and reducing the number of hospital visits.
2. Interstitial Lung Disease (ILD):
This is a group of lung conditions that cause scarring to the lungs over time. Severe ILD might lead to chronic hypoxemia. While there is no direct research about using LTOT in ILD patients, it is believed that using LTOT might improve their survival and prevent complications based on the outcomes in COPD patients.
3. Pulmonary Hypertension:
Although there’s no proof that LTOT can improve survival rates in patients with pulmonary hypertension (high blood pressure in the lungs), it can increase the amount of oxygen in the tissues and prevent complications. The only exception is pulmonary hypertension caused by COPD where it might actually help improve life expectancy.
4. Cystic Fibrosis (CF):
People with severe CF who develop chronic hypoxemia may benefit from LTOT, as it could potentially improve their survival rate and prevent complications. However, there is no specific research on this topic, and advocacy for the use of LTOT comes from its proven benefits in COPD patients.
5. Advanced cardiac failure:
While no studies have specifically researched the use of LTOT in patients with severe heart failure, it could potentially improve tissue oxygenation and prevent complications related to low oxygen levels in the blood.
Generally, the goal in using oxygen therapy for these conditions is to help improve the patient’s quality of life, lengthen survival where possible, and prevent additional medical complications associated with low oxygen levels (hypoxemia).
When a Person Should Avoid Home Oxygen Therapy
There’s only one outright situation where home oxygen therapy should not be used. This is for people who continue to smoke cigarettes. This is because having an oxygen supply around while smoking increases the risk of a fire significantly. Similarly, it’s important to keep oxygen equipment like cylinders away from fire or any electrical wiring at home.
Equipment used for Home Oxygen Therapy
There are many devices available for people who need to use oxygen at home. This includes concentrators, liquid systems, cylinders, and generators. Which oxygen delivery system is used depends on the patient’s health condition and the level of oxygen they need. It also depends on what type of device the patient is most comfortable with.
There are several ways to deliver oxygen therapy at home, including:
– One option is a low-flow nasal cannula, which supplies a small amount of oxygen (1 to 6 liters per minute). For each liter per minute of oxygen, about 3% to 4% is added to the oxygen concentration. The oxygen delivered by the nasal cannula mixes with the air in the room. Therefore, the concentration of oxygen depends on the patient’s breathing rate, volume of air inhaled in a single breath (tidal volume), oxygen flow rate, and how much they breathe through their mouth.
Simple oxygen masks can provide an oxygen flow of rates between 6 and 10 L per minute with oxygen concentrations between 35% and 50%. This depends on the patient’s breathing rate and how well the mask fits. In a simple mask, oxygen is delivered through a small tube connected at the base of the mask. The gas you breathe out escapes through holes on each side of the mask. Room air enters through these holes and mixes with the oxygen, so a flow rate greater than 5 L per minute is necessary to avoid breathing in too much carbon dioxide (CO2). There are also Venturi masks, which allow for specific controlled levels of oxygen, between 24% to 40%. These masks may benefit patients with severe breathing problems who require long-term oxygen therapy.
There are other devices available that don’t touch the face but do touch the head.
Preparing for Home Oxygen Therapy
When deciding if someone needs Long-Term Oxygen Therapy (LTOT), doctors often use a handy tool called a pulse oximeter. This gadget measures the oxygen level in your blood and is a good way to identify people who might need LTOT. Research has shown that an oxygen level reading of 92% is a strong indicator for those who may require LTOT. In simpler terms, if you are stable and your blood oxygen level is around 92%, you might be referred for more tests to explore if you need LTOT.
Moreover, if your oxygen level reads 94% and you have signs of symptoms like swelling in the legs, arms, or ankles (peripheral edema), high levels of red blood cells (hematocrit equal to 55%), or high blood pressure in your lungs’ arteries (pulmonary hypertension), you may also be referred for additional tests to see if LTOT is right for you.
It’s also important to check in with your doctor after starting LTOT. In general, you’ll have a follow-up appointment three months after starting, as part of making sure it’s still needed. After that, you should see your doctor every 6 to 12 months. This helps ensure the therapy is still the best option for your health.
Possible Complications of Home Oxygen Therapy
If you’re receiving oxygen therapy at home, which is when you receive oxygen in high levels (more than 50%) for a long time, you might run into some side effects. These could include atelectasis (a condition where the lungs partly or fully collapse), oxidative stress (an imbalance in the body that can damage cells), and peripheral vasoconstriction (when your blood vessels narrow). But even with these possibilities, the benefits of receiving oxygen usually outweigh the negative side effects.
However, you should be careful if you have chronic obstructive pulmonary disease. If too much oxygen is given to you, it can lead to a worsening condition where there’s too much carbon dioxide in your blood. To prevent any harm and to prevent your tissues from not getting enough oxygen, your doctors will aim to keep your oxygen saturation levels (SpO2—the percentage of oxygen in your blood) between 90% and 92%.
Safety at home is also important. Be cautious of having any open flames, like candles or stoves, close to your oxygen. It’s recommend to keep your oxygen containers at least 5 feet away from any sources of heat or electrical devices to keep you safe.
It’s also important to note that there’s a big risk of fire if someone smokes while using home oxygen therapy. It’s a good idea to quit smoking altogether. That recommendation, alongside a few others, should be given to you in writing by your doctor before you begin using at home oxygen.
There can be other, smaller side effects, like irritation or bruising around the mask or nasal cannula (the tube used to deliver oxygen), a dry nasal passage that might result in nosebleeds, and feelings of tiredness or headaches in the mornings. These side effects are tied to oxygen therapy.
