OXYGEN

We Must Stress that the following pages are for comment ONLY. It is important that you follow the directions given by your Consultant, GP or Respiratory Nurse. We are not doctors.

Question what they tell you, but don’t just ignore it.

We may all need oxygen as our condition deteriorates, and yet we 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 none of us would be alive! But seriously it is not addictive in the sense in which the nurse meant it, but you should not exceed the recommended flow of oxygen to your lungs.

Paramedics never deliver more than 2 litres per minute of oxygen until their patients have been properly assessed in hospital. Delivering too much oxygen may actually worsen your ability to breathe leading to respiratory arrest (it can also depresses your respiratory drive).

If you require oxygen your GP, your Consultant or Respiratory Nurse will tell you what the recommended flow rate should be for you.

 ·       See  OXYGEN EQUIPMENT/SUPPLIERS  PAGE ABOVE FOR PATIENTS WITH PROBLEMS CONCERNING OXYGEN SUPPLY

At sea level the atmosphere contains about 21% oxygen, and the higher up you live the less oxygen there is, 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.

Q       How do I know if I have low oxygen levels in my blood?

Well firstly to 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 can be confusing the first time a patient hears it so to re-word it simply in % terms.  O₂ is the chemical name for oxygen. 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 at REST and is unlikely to drop with exertion - their limiting factor with be heart rate and fitness.

Q       How do they measure the need for oxygen?

A reading is taken by placing a 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.

The photograph below is not very clear, but if you could see it, it shows a reading of O₂ level of 96% at rest, which is good but the pulse rate is rather high at 90. This can happen if a person is nervous.  Recent models are about half the size of this one.

If oxygen readings at rest are 92% or below you probably need to have further tests in hospital and may have to breathe in extra oxygen for most of the day. Oxygen Therapy can be vital and is certainly beneficial in order to add more years to your life.

Q       Will I need to be on oxygen 24/7?

Many patients with COPD and Emphysema require LONG TERM OXYGEN THERAPY (LTOT). But there are many people with COPD who don't need LTOT.

Most people with a resting oxygen level of around 92% to 94% or even higher, may experience a drop below 90% with exercise. If this happens it is an indicator that you should consider using oxygen while you exercise. Again, if you have a resting rate under 94% you may also have a lower count at night. When asleep your breathing is more relaxed and you may take in less oxygen. Unfortunately there is a long waiting list for sleep studies on this subject.

Q       Do I need oxygen at night?

If possible, purchase or borrow a pulse oximeter from your GP or Respiratory Nurse and measure your oxygen levels every 2 hours. A reading below 88% would indicate a requirement to discuss the possible need for oxygen at night.If you need oxygen and you don't have it, then the stress on your internal organs will damage them over time, in particular your heart. Other advantages of LTOT are improved life expectancy, and improved condition of your health and heart.

Q       What about my pulse rates?

At rest your pulse rate may be higher than normal and may vary from 78 to 100 pulses per minute. Your heart has to work harder to help you breathe and push round sufficient blood to send enough oxygen to your muscles. It is not your pulse rates that set limits for exercise, but it is your breathlessness combined with falling oxygen levels in your blood.Pulse rates at 100 or above will eventually harm your heart so it is best to use oxygen to reduce the level or learn how to relax!!

Q       What happens to my oxygen levels when I move around?

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 you move about or even bend down to pick something up you may get very breathless, this is because your sats have fallen.When you move around quickly or climb up the stairs your sats quickly fall from say 94% to 80%. This is bad because although your sats will recover quite quickly, repeated drops like this throughout the day will place too much strain on your internal organs, especially your 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.

Q       What is de-saturation?

A drop in oxygen levels is called DE-SATURATION and if your oxygen levels fall to around 86% on exercise you should be offered AMBULATORY OXYGEN.

Q       What is ambulatory oxygen?

This is a lightweight container that you can carry around with you on your shoulder or your back and it delivers oxygen to keep your sats above 90%. (Usually at a rate of 2 litres per minute - this is the absolute maximum unless you have been assessed otherwise, because a higher rate might cause your CARBON DIOXIDE (CO₂) levels to rise or your respiratory drive to be depressed and this is not good for you.

Q       Can I still exercise while using oxygen?

You can exercise safely with oxygen either inside or outside the house. You will build up your muscles and they will then use less oxygen. This 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 your sats are falling your journey to the shops for example will be painful, you will need to stop 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.

If you exercise a little each day without oxygen and build it up slowly or exercise a bit more with oxygen, you should get fitter and be able to do more without oxygen.

HINT - WHEN CLIMBING THE STAIRS BREATHE IN THEN WALK UP A FEW STEPS WHILE BREATHING OUT. STOP & BREATHE IN and REPEAT.

Q       Can I still exercise while using oxygen if I go to Rehabilitation?

YES – regular exercise will improve your ability to continue doing every day things. Using Oxygen will make it easier to build up your stamina. You will also meet new friends, other people with breathing difficulties to share your experiences with. Ask your Respiratory Nurse for details about Pulmonary Rehab programs in your area.

Q       Do only SEVERE EMPHYSEMA or COPD patients need oxygen?

Some people unfortunately need oxygen at rest or on movement when they have only MODERATE COPD. Everybody is different and if you do need oxygen therapy your Consultant will explain it to you.

Q       How is oxygen delivered if I need it most of the time?

If you need to be on oxygen for say 4 hours a day or more inside the house then you will probably be given a CONCENTRATOR.

Q       How does a Concentrator work?

This is a machine, which is plugged into the mains electricity supply and can be operated 24/7 if required. It extracts oxygen from the air and delivers it to you through either a facemask or through a nasal cannula.

Q       What if I can’t afford to run it?

It has a little meter that measures the amount of electricity used and you won't have to pay for that. You will receive a cheque from your service provider every so often to help pay for your electricity.

Q       Can I only use it downstairs?

No, you will be able to use wherever you are in the house or garden. Thin oxygen tubes can be cabled through the house both upstairs and downstairs so you can move around freely using it, even in the garden.

NOTE: Beware not to have Oxygen on if you are cooking with gas or sitting close to a gas fire!

Q       How many hours should I use the oxygen if I am advised to use oxygen as a long-term therapy?

You will be told how many hours you need to use it for when you are assessed.

Q       Will I get tangled up with all the cabling?

No - You soon get used to it and don’t feel tied to the machine - the service provider will ensure that the cables are secured to the stairs and skirting boards. They can provide you with tap so you can re-direct the oxygen flow upstairs at night and from your bedroom to the bathroom.Whilst the tubing and cannula supplied in the UK can be a bit hard, especially if you have a sensitive nose, it is possible to obtain a softer, tangle-free type from the US.

Q       What level should the concentrator be set at?

You need to be assessed and advised on how to use the equipment for your own needs. No two people are alike.

Q       What happens if there is a power failure?

You will be supplied with sufficient oxygen cylinders to use in an emergency. Your electricity service provider should be notified that you are ‘at risk’ if there is a power failure.

Q       Can I use my oxygen cylinders in the car?

YES.

Ambulatory Oxygen – for use out of doors

With AMBULATORY OXYGEN the cylinders weigh about as much as a lightweight shopping basket or say 3 kilo bags of sugar when full. You might have to use more than 2 litres to move around but you should be assessed for this. John was not because there was no one around to test him so he used 3 or 4 litres but only when exercising!! NOT AT REST.

Unfortunately there are still some GPs and even Respiratory Nurses who do not consider ambulatory oxygen to be necessary unless you need LTOT (Long Term Oxygen Therapy).

John went on record as saying that this was a dreadful mistake and often confined people to a chair for the rest of their life. When John first used ambulatory oxygen he purchased liquid oxygen for £300 a month. He was told by his GP that it would be too dangerous, that he would burn his face and hands but John talked to the company and they said that if he was careful and didn't smoke (which he didn't!) then it was safe. It transformed his life and allowed him to take short walking holidays, he previously thought were beyond him (see John’s diary web site).

When John first received his ambulatory oxygen system, he was rather self-conscious about using it in the streets or shops. He thought people would stare at him, avoid him or be scared if he went into a shop. It took him about two weeks to discover that hardly anybody looked at him in an odd way and that if he smiled and gave a greeting (where appropriate!) they always smiled back. He suggested that you should go out with a friend or partner or a 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, above.

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.

Portable Oxygen Concentrators

If you have plenty of money there is are EXCITING new portable concentrators - at the cutting edge of high technology. However John had to sell his because it did not deliver a high enough level of oxygen for him. There are some good web sites that will provide more information – Google : Portable Oxygen Concentrators.

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 you may or may not have already developed an exacerbation. You must look out for occasional swelling of your anklesor 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 need it?

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. If you climb the stairs and your sats drop or you feel panicky because you are not recovering quickly enough, a few minutes on oxygen will help.

Updated and edited by Terry Mackay  August 2008