OXYGEN
We all need oxygen, and yet I have heard of a respiratory nurse who told one of her patients that she couldn't have oxygen to walk around outside her home, because it was addictive. Well if it wasn't then I guess none of us would be alive! But seriously it is not addictive in the sense in which the nurse meant it, but you must not exceed the recommended flow of oxygen to your lungs. Ambulances never deliver more than 2 litres per minute of oxygen until their patients are properly assessed. Too much oxygen may actually worsen your ability to breathe leading to respiratory arrest (it depresses your respiratory drive).Your GP or most probably your Consultant or Respiratory Nurse will tell you what that is and recommend a flow rate after testing if indeed you need it at all.
See SITEPAGE FOR DETAILS OF A NEW WEB SITE FOR PATIENTS WITH PROBLEMS CONCERNING OXYGEN.At sea level the atmosphere contains about 21% oxygen, and the higher up you live the less oxygen, but this doesn't really affect people in the UK! If you have low oxygen levels in your blood then the aim would be to increase the concentration of oxygen in inhaled air to around 30% by using oxygen equipment.
How do I know if I have low oxygen levels in my blood?
Well firstly I should perhaps define oxygen measurements. GPs or more commonly consultants/respiratory nurses may tell you that you need oxygen because your PaO2 falls below 8kPa at rest. Well this is gobbledegook to me, as I expect it is to you, so I'll use a different type of measurement, in % terms. Firstly O2 is the chemical name for oxygen. Now a healthy person, depending upon their age and fitness, will have an oxygen level in their blood between 96 and 98% and generally speaking probably 97 to 98% , and that reading will be taken when you are at REST. And generally in a healthy person this will not drop with exertion - their limiting factor with be heart rate and fitness.
The reading will be taken by placing your finger into a PULSE OXIMETER. This takes a reading of your % and your pulse. Normally pulse rates vary a little at rest for healthy people but 72 per minute is given as about average. This photograph below was taken this January 7th 2006 showing my reading - note the O2 levels are 96%(lower figure) at rest which is good but the pulse rate is rather high at 90 (probably nervous as well!). A year late 2007 they had dropped to 92%!
Now if your oxygen readings at rest are below 92% or below you will need to have further tests in hospital and may have to breathe in extra oxygen for most of the day. This is vital to add more years to your life.
My oxygen levels varies from 90 to 92% at rest so that means I do need LTOT, which means LONG TERM OXYGEN THERAPY. But many people with COPD don't need LTOT and I hope that they never will. However, most people with a resting % of say 92 to 94% or even higher may experience a drop below 90% with exercise. If this happens you should use oxygen for exercise.
Again if you have a resting rate under 94% you may have a lower count at night. When asleep your breathing is more relaxed and may take in less oxygen. Unfortunately there is a long waiting list for sleep studies on this subject. Borrow a pulse oxineter from your GP and get someone to measure your oxygen levels every 2 hours - that is a good way to find out. Anything below 88% would indicate a definite need for oxygen at night.
But if you need it and you don't have it, then the stress on your internal organs will damage them and in particular your heart. Some other advantages of LTOT are improved life expectancy, health and heart status.
What about my pulse rates?
Well at rest my pulse rate is higher than normal and varies a lot from 78 to 100 pulses per minute. My heart has to work harder to help me breathe and push round my blood to send enough oxygen to my muscles and so forth. Don't worry about that too much. It is not our pulse rates that set limits for exercise but it is our breathlessness combined with falling oxygen levels in our blood.
However pulse rates at 100 or above will eventually harm your heart so it is best to use oxygen to reduce them or learn how to relax!!
When I move about I get very breathless, even bending down to pick something up, what happens to my oxygen levels?
Well firstly let me introduce you to a new phrase - oxygen saturation levels. This is measured again in % levels, as described above. You've probably heard someone say on Casualty or Holby City on TV "his sats. are dropping." Well now you know what it means.
When I move around quickly or climb up the stairs my sats. quickly fall from say 94% to 80%. Now this is bad because although my sats. recover quite quickly, repeated drops like this throughout the day will place too much strain on my internal organs, especially my heart. It is likely that all people with a saturation level at rest of between 91 and 94% will experience a fall below 90% on moving around. You should ask your GP for a test and then ask about oxygen.
This drop in oxygen levels is called DESATURATION and if your oxygen levels fall to 86% or so on exercise you should be offered AMBULATORY OXYGEN. This is just a lightweight container that you carry around with you on your shoulder or your back and the oxygen it delivers keeps your sats. above 90%. I use it and set the oxygen level to two litres a minute. This is the absolute maximum unless you have been assessed otherwise, because a higher rate might cause your CARBON DIOXIDE levels to rise (CO2) or your respiratory drive to be depressed (see above)and this is a bad thing. However I need 2-3 litres to work out but never at rest!
If you exercise safely with oxygen either inside the house or outside then you will build up your muscles and they will then use less oxygen. Thus means you will be able to do more things, like going upstairs for example, without becoming breathless or having to use oxygen. If you don't use oxygen when you are desaturating (meaning your sats. are falling) your journey to the shops for example will be painful, stopping every few yards, and it might put you off going to the shops at all!! Being housebound is NO FUN AT ALL and oxygen gives you FREEDOM.
HINT - WHEN CLIMBING THE STAIRS BREATHE IN THEN WALK UP A FEW STEPS WHILE BREATHING OUT. STOP & BREATHE IN and REPEAT.
Do only SEVERE EMPHYSEMA OR COPD patients need oxygen?
I know some people unfortunately who need oxygen at rest or on movement when they have only MODERATE COPD. Everybody is different and I can't tell you any more than that. If you do need it, your CONSULTANT will explain it to you.
How are my oxygen levels measured?
Well I, and most GP practices have what is known as a PULSE OXIMETER, as I mentioned above. I truly recommend that you buy one. I know they can be expensive but I use mine all the time. Just to check on how I'm doing, as you would to check the time. Being just breathless is not a guide to oxygen levels. Healthy people get breathless but their oxygen levels do not plunge down like mine - they are just unfit. Visit your GP or practice nurse at least twice a year to have your oxygen levels checked.
If you exercise a little each day without oxygen and build it up slowly or exercise a bit more with oxygen, you WILL get fitter and be able to do more without oxygen. And you can prove that with your OXIMETER!!
HOW IS OXYGEN DELIVERED?
Well if you have to be on oxygen for say 4 hours a day or more inside the house then you will probably be given a CONCENTRATOR. This is a machine which extracts oxygen from the air and is plugged into the the mains electricity supply. It has a little meter that measures the electricity used and you won't have to pay for that. Thin oxygen tubes can be arranged anywhere in your house so you can move around freely using it, even in the garden. You can either place the tubes in your nose (known as NASAL PRONGS OR NASAL CANNULAE or wear a FACE MASK. I use NASAL PRONGS, as shown below in the photographs.
IF I AM TOLD TO USE OXYGEN AS A LONG TERM THERAPY FOR HOW MANY HOURS SHOULD I USE IT?
Well we are talking at rest here. For a minimum for 16 hours to get better results but I err on the safe side and use it 24/7. You soon get used to it. I never feel tied to the machine - the only tiresome thing is to untangle the 15 m tubes as I go about the house. If you have a very tidy partner they will have a fit!!
AT WHAT SETTING SHOULD I USE?
I deally you should be assessed - ask for this but until then never more than a 2 litre setting. I use 1 at night and 1 and a half to 2 in the day. There is always a danger of getting too much oxygen and then your body cannot get rid of enough carbon dioxide when you breathe out.
With AMBULATORY OXYGEN the cylinders weigh about as much as a lightweight shopping basket or say 3 kilo bags of sugar when full. Here are two photographs of me using the old DD oxygen cylinders and one using a liquid oxygen system. For the new non-liquid systems please see PREVIOUS PAGE. You might have to use more than 2 litres to move around but you shoulod be tested for this. I was n't because there was no-one around to test me so I use 3 or 4 litres but only when exercising!!
NOT AT REST - I MUST REPEAT THAT.
LEFT PICTURE WITH OLD DD SYSTEM. RIGHT PICTURE WITH LIQUID OXYGEN SET.
Unfortunately there are still some GPs and even Respiratory Nurses who do not consider ambulatory oxygen is necessary unless you have LTOT (Long Term Oxygen Therapy). I should like to go on record as saying that this is a dreadful mistake and often confines people to a chair for the rest of their life.
When I first used ambulatory oxygen I purchased liquid oxygen for £300 a month - it was liquid oxygen. First I was told by my GP that it would be too dangerous, that I would burn my face and hands but I talked to the company and they said that if I was careful and didn't smoke (I don't!) then it was safe. It transformed my life and allowed me to take short walking holidays, that I thought were beyond me (see my diary web sit). The alternative at the time was a compressed oxygen cylinder which weighed over 4 kilogrammes - see above photograph on the left. The new compressed air cylinders are nearly I kilogramme lighter (a bag of sugar!).
I ought to add that when I first received my ambulatory oxygen system, as above in left picture, I was rather self-conscious about using it in the streets or shops. I thought people would stare at me, avoid me or be scared if I went into a shop. It took me about two weeks to discover that hardly anybody looked at me in an odd way and that if I smiled and gave a greeting (where appropriate!) they always smiled back. I suggest that you go out with a friend or partner or group when you first use it. Within weeks it will feel TOTALLY NORMAL and exercising in fresh air without being out of breath all the time is FANTASTIC.
You can also use oxygen to exercise indoors. See EXERCISE page.
You will only receive LIQUID OXYGEN on the NHS if you need to be outside the house at least 4 hours a day, perhaps working for money or as a volunteer, or in need of a high flow of oxygen, for example if you are due for an operation. It is expensive. However, most people who need it will get it provided that they have a safe environment.
If you have plenty of money there is an EXCITING new portable concentrator - at the cutting edge of high technology.
THIS IS THE NEW SYSTEM. HOWEVER I HAD TO SELL IT BECAUSE IT DID NOT DELIVER A HIGH ENOUGH LEVEL OF OXYGEN FOR ME.
I am a carer but I do not have an oximeter. What are the symptoms to look out for in my patient/partner to indicate that they are suffering from low oxygen levels?
The patient/partner or indeed yourself may or may not have already developed an exacerbation. You must look out for occasional swelling of your ankles or a bluish tinge round the mouth or tongue, also mental confusion and excessive drowsiness. If you notice these things contact your GP at once.
What does hypoxia mean?
It means an abnormally low oxygen content within the organs and tissues of the body as a result of COPD for example. And this will result in breathlessness.
What does dyspnoea mean?
Your GP might ask you if you suffer from dyspnoea - it means quite simply difficulty in breathing.
Should I keep an oxygen cylinder just in case I or my partner need it?
I did. If you have an exacerbation, that does not require a hospital admission, it will help you to breathe from time to time or at least until the GP arrives. Also if you climb the stairs and your sats. drop and you feel panicky because you are not recovering quick enough a few minutes on oxygen will help.