Oxygen Therapy: Types, Benefits & Home Treatment

What Is Oxygen Therapy and How Does It Work?

Oxygen therapy is a medical treatment that delivers supplemental oxygen to increase blood oxygen levels in patients with hypoxemia. It works by providing a higher concentration of oxygen than normal air (21% oxygen), allowing more oxygen to reach your bloodstream and vital organs through breathing.

Some medical conditions can cause your body to need more oxygen than what is available in normal air. If you have a significant oxygen deficiency, you may receive oxygen therapy. The supplemental oxygen increases the amount of oxygen in your blood, helping your heart, brain, and other organs function properly.

The air we normally breathe contains approximately 21% oxygen. Oxygen therapy delivers concentrations ranging from 24% to 100% depending on the patient's needs and the delivery method used. This additional oxygen is absorbed through the lungs into the bloodstream, where it binds to hemoglobin in red blood cells and is transported throughout the body to tissues and organs that require it for proper function.

Blood oxygen levels are measured using two primary methods. A pulse oximeter is a non-invasive device clipped to your finger that measures oxygen saturation (SpO2) - normal levels are typically 95-100%. For more precise measurements, an arterial blood gas (ABG) test measures the partial pressure of oxygen (PaO2) directly from blood drawn from an artery, usually in your wrist. This test also measures carbon dioxide levels and blood pH, providing a complete picture of respiratory function.

The Physiology of Oxygen Transport

Understanding how oxygen moves through your body helps explain why supplemental oxygen can be so beneficial. When you inhale, oxygen travels through your airways to tiny air sacs called alveoli in your lungs. Here, oxygen molecules cross the thin alveolar membrane into tiny blood vessels called capillaries. The oxygen then binds to hemoglobin molecules in your red blood cells, which carry it through your bloodstream to every cell in your body.

Cells use oxygen in a process called cellular respiration to produce energy (ATP) from nutrients. This energy powers all bodily functions, from muscle movement to brain activity to organ function. When oxygen levels are too low (hypoxemia), cells cannot produce adequate energy, leading to symptoms such as shortness of breath, fatigue, confusion, and in severe cases, organ damage or failure.

Conditions That Require Oxygen Therapy

Oxygen therapy may be prescribed for both acute (short-term) and chronic (long-term) conditions. Understanding when oxygen therapy is needed helps patients and caregivers recognize the importance of this treatment.

• Chronic obstructive pulmonary disease (COPD): The most common reason for long-term oxygen therapy, particularly in advanced stages
• Pulmonary fibrosis: Scarring of lung tissue that impairs oxygen absorption
• Pneumonia: Lung infection that may temporarily reduce oxygen levels
• Severe asthma: During acute exacerbations that compromise breathing
• Heart failure: When the heart cannot pump blood efficiently, oxygen levels may drop
• Sleep apnea: Sometimes used in conjunction with CPAP therapy
• COVID-19 and other respiratory infections: During recovery from severe illness
• Cystic fibrosis: Genetic condition affecting the lungs
• Pulmonary hypertension: High blood pressure in the lung arteries

How Is Oxygen Therapy Administered?

Oxygen therapy is administered through several methods depending on oxygen requirements: nasal cannula (thin tubes in nostrils) for 1-6 L/min, simple face masks for 5-10 L/min, non-rebreather masks for high-flow oxygen, and mechanical ventilators for severe respiratory failure. The choice depends on the patient's condition and oxygen needs.

You can receive oxygen therapy through your nose, or through both your nose and mouth depending on how much oxygen you need. The delivery method is chosen based on the amount of supplemental oxygen required, patient comfort, and the clinical setting. Each method has specific advantages and is suited to different situations.

Nasal Cannula

The nasal cannula is the most common oxygen delivery device for patients who need low to moderate supplemental oxygen. It consists of a thin, soft plastic tube with two small prongs that fit into your nostrils. The tubing loops over your ears and can be secured with a slider under your chin for comfort and stability.

Nasal cannulas typically deliver oxygen at flow rates of 1 to 6 liters per minute (L/min), providing oxygen concentrations of approximately 24-44% depending on the flow rate and the patient's breathing pattern. The main advantages of nasal cannulas include comfort, the ability to eat and speak normally, and suitability for long-term use. However, they may not be suitable for patients who primarily breathe through their mouths or those who need higher oxygen concentrations.

Some patients experience discomfort from the cannula pressing against their nose, ears, or face. This can usually be managed by using foam ear protectors, adjusting the fit, or applying a thin layer of water-based lubricant to the nostrils. If you experience persistent discomfort, inform your healthcare provider.

Oxygen Masks

When you need more oxygen than a nasal cannula can provide, your healthcare team may recommend an oxygen mask. The mask covers both your mouth and nose, creating a semi-sealed environment that delivers higher oxygen concentrations. It is typically secured with elastic straps around your head. You can remove the mask when eating or drinking.

There are several types of oxygen masks, each designed for specific oxygen requirements:

• Simple face mask: Delivers 5-10 L/min, providing 35-50% oxygen concentration. Suitable for moderate oxygen needs.
• Partial rebreather mask: Has a reservoir bag that allows some exhaled air to be rebreathed, conserving oxygen. Delivers 40-70% oxygen at 6-10 L/min.
• Non-rebreather mask: Features a reservoir bag and one-way valves that prevent exhaled air from entering the bag. Delivers 60-95% oxygen at 10-15 L/min. Used for severe hypoxemia.
• Venturi mask: Provides precise, controlled oxygen concentrations (24-60%) regardless of patient breathing pattern. Commonly used in COPD patients where precise oxygen delivery is important.

As with nasal cannulas, masks may cause some discomfort, including pressure on the face and dryness around the nose. Moisturizers and proper fit adjustments can help alleviate these issues.

High-Flow Nasal Cannula (HFNC)

High-flow nasal cannula is an advanced oxygen delivery system that can provide heated, humidified oxygen at very high flow rates (up to 60 L/min). This technology has become increasingly important in treating severe respiratory conditions and was widely used during the COVID-19 pandemic. HFNC provides better oxygenation than standard nasal cannulas while maintaining patient comfort and allowing normal eating and speaking.

Mechanical Ventilation

For certain surgeries or severe illnesses, patients may need additional help getting air in and out of their lungs. In these cases, treatment with a mechanical ventilator (respirator) may be necessary. A ventilator is a machine that takes over or assists the breathing process, delivering oxygen directly into the lungs through a tube inserted into the airway (intubation) or through a mask for non-invasive ventilation.

Mechanical ventilation is typically used in intensive care settings for patients with severe respiratory failure, during general anesthesia for surgery, or for patients who cannot breathe adequately on their own due to illness, injury, or neurological conditions.

Can I Receive Oxygen Therapy at Home?

Yes, home oxygen therapy (also called Long-term Oxygen Therapy or LTOT) is a well-established treatment for patients with chronic respiratory conditions. Your healthcare team will train you on equipment use and safety. Treatment is monitored regularly through follow-up appointments to assess your condition and adjust oxygen levels as needed.

You may need oxygen therapy at home if you have a chronic condition that causes persistently low blood oxygen levels. Your healthcare provider will demonstrate how to handle the oxygen equipment and explain important safety precautions. For example, oxygen is highly flammable, so you must never have open flames in your home when using oxygen equipment.

Before starting home oxygen therapy, you will typically undergo an arterial blood gas test to precisely measure how much supplemental oxygen you need. This test involves drawing blood from an artery, usually on the inside of your wrist. Based on the results, your doctor will prescribe a specific oxygen flow rate and determine how many hours per day you should use the oxygen.

Types of Home Oxygen Equipment

There are three main types of oxygen systems used for home therapy, each with distinct advantages depending on your lifestyle and oxygen requirements:

• Oxygen concentrators: Electric devices that extract oxygen from room air, concentrating it for delivery. They are the most cost-effective option for home use, require no refills, and can run continuously. Larger stationary units provide higher flow rates, while portable concentrators allow mobility.
• Compressed oxygen cylinders: Metal tanks containing pressurized oxygen gas. Available in various sizes from small portable cylinders to large stationary tanks. Require regular refill or replacement but do not need electricity.
• Liquid oxygen systems: Store oxygen in liquid form at very cold temperatures, allowing more oxygen in a smaller container. A large stationary reservoir can refill smaller portable units. Ideal for active patients who need higher flow rates while mobile.

Getting Started with Home Oxygen

When you begin home oxygen therapy, a respiratory therapist or equipment supplier will visit your home to set up the equipment and provide comprehensive training. This includes how to operate the devices, change settings, connect tubing, and troubleshoot common issues. They will also review important safety precautions and answer any questions you have.

Your treatment will be monitored regularly to assess how you are feeling and whether adjustments are needed. Some patients can eventually stop treatment if their condition improves, while others may need oxygen therapy indefinitely. Never change your prescribed oxygen settings without first consulting your doctor, as both too little and too much oxygen can be harmful.

What Safety Precautions Are Important with Oxygen Therapy?

Critical safety rules for oxygen therapy include: never smoke or allow smoking near oxygen equipment, keep oxygen away from open flames and heat sources, store cylinders upright and secured, ensure adequate room ventilation, never use oil-based products near oxygen, and always follow prescribed flow rates.

Oxygen itself does not burn, but it supports and accelerates combustion. This means that fires near oxygen burn faster and hotter than normal. Following safety precautions is essential to prevent accidents and ensure safe treatment.

Fire Safety

Fire safety is the most critical aspect of oxygen therapy safety. The increased oxygen concentration around your equipment creates an environment where fires can start more easily and spread more rapidly. Essential fire safety precautions include:

• Never smoke: Do not smoke while using oxygen, and do not allow others to smoke near you or your equipment. This is the number one cause of fires related to oxygen therapy.
• Avoid open flames: Keep oxygen equipment at least 2 meters (6 feet) away from candles, gas stoves, fireplaces, and other sources of open flame.
• No heat sources: Keep oxygen away from heaters, radiators, and heat-generating appliances.
• Avoid flammable products: Do not use oil-based creams, petroleum jelly, or alcohol-based products on your face when using oxygen. Use water-based products instead.
• Static electricity: Use cotton blankets and clothing rather than wool or synthetic materials that can generate static sparks.

Equipment Safety

Proper handling and storage of oxygen equipment is important for both safety and ensuring effective treatment:

• Store cylinders properly: Keep oxygen cylinders upright and secured so they cannot fall over. Use cylinder stands or secure them to a wall.
• Ventilation: Ensure adequate ventilation in rooms where oxygen is used. Do not use oxygen in small, enclosed spaces.
• Check equipment: Regularly inspect tubing, connections, and devices for damage or wear. Replace worn components promptly.
• Keep equipment clean: Follow manufacturer instructions for cleaning and maintaining your equipment.
• Have a backup plan: Know what to do if your equipment fails. Have emergency contact numbers readily available.

What Are the Side Effects of Oxygen Therapy?

Common side effects of oxygen therapy include dry or sore nose, skin irritation around nose and ears, nosebleeds, dry mouth and lips, and headaches. Most side effects are mild and can be managed with moisturizers, proper equipment fitting, and humidification. Serious complications like oxygen toxicity are rare and occur mainly with very high oxygen concentrations.

The treatment can cause your nose and the area around it to become dry and sore. You may also experience dryness on your face or lips if you use an oxygen mask. There are various ointments and nasal sprays available over the counter at pharmacies that can help. Different products work better for different people, so you may need to try a few options.

Ask the pharmacy staff for advice if you are unsure which product to choose. You can also consult your doctor if you have questions about managing side effects.

Common Side Effects and Solutions

• Dry nose and nosebleeds: Use saline nasal spray or gel to keep nasal passages moist. A humidifier bottle attached to your oxygen source can add moisture to the oxygen you breathe.
• Skin irritation: Foam cushions or pads can protect areas where the cannula or mask rests. Ensure proper fit to minimize pressure points.
• Dry mouth: If using a mask, keep your mouth closed when possible. Sip water regularly and use lip balm. You may also experience symptoms of dry mouth that require additional management.
• Ear discomfort: Foam ear protectors can cushion the tubing where it loops over your ears.
• Headaches: Usually mild and often improve as you adjust to therapy. Inform your doctor if headaches persist.

Speak with your healthcare provider if these self-care measures do not help or if you experience any concerning symptoms.

Rare but Serious Complications

Oxygen toxicity can occur with prolonged exposure to very high oxygen concentrations (typically above 50% for extended periods). This is mainly a concern in hospital settings with mechanical ventilation. Symptoms may include chest pain, difficulty breathing, cough, and in severe cases, damage to the lungs. Home oxygen therapy at normal prescribed levels does not cause oxygen toxicity.

In some patients with severe COPD, the body's breathing drive partially depends on low oxygen levels. Very high oxygen levels could theoretically reduce this drive. However, this is uncommon and should not prevent patients from using their prescribed oxygen. Your doctor will prescribe appropriate oxygen levels based on your specific condition.

What Are the Benefits of Long-term Oxygen Therapy?

Long-term oxygen therapy (LTOT) significantly improves survival in patients with severe COPD and chronic hypoxemia, extending life by 3-5 years with proper use (>15 hours daily). Benefits also include improved exercise capacity, better sleep quality, reduced breathlessness, improved cognitive function, and enhanced quality of life.

With treatment, most patients feel better and experience less fatigue. You may still feel short of breath during physical exertion because supplemental oxygen is not a treatment for breathlessness itself - it treats low blood oxygen levels. However, by ensuring adequate oxygen delivery to your muscles and organs, it can help you be more active and feel better overall.

The survival benefits of long-term oxygen therapy for COPD patients are well-established through landmark clinical trials. The Nocturnal Oxygen Therapy Trial (NOTT) and the Medical Research Council (MRC) trial demonstrated that patients using oxygen for more than 15 hours daily had significantly better survival rates than those using oxygen only at night or not at all.

Specific Benefits of Oxygen Therapy

• Extended survival: For patients with severe COPD and chronic hypoxemia, LTOT can add 3-5 years to life expectancy when used for more than 15 hours daily.
• Improved exercise tolerance: Adequate oxygen allows muscles to work more efficiently, enabling greater physical activity.
• Reduced breathlessness: While oxygen does not directly treat the sensation of breathlessness, it can reduce the work of breathing.
• Better sleep: Patients often sleep better and wake feeling more rested.
• Improved cognitive function: Adequate oxygen to the brain supports better concentration, memory, and mental clarity.
• Reduced strain on the heart: Low oxygen levels force the heart to work harder; supplemental oxygen reduces this burden.
• Better quality of life: Many patients report improved mood, energy levels, and ability to participate in daily activities.

You may need to resume oxygen therapy if your condition worsens after stopping treatment. Regular monitoring helps determine your ongoing oxygen needs.

How Do I Prepare for Oxygen Therapy?

For hospital oxygen therapy, no special preparation is needed. For home oxygen therapy, you will need an arterial blood gas test to determine your oxygen needs, training on equipment use and safety, home assessment for equipment placement, and understanding of your treatment plan including when and how long to use oxygen.

You do not need to prepare anything specific if you will receive oxygen therapy in a hospital setting. Healthcare staff will set up the equipment and explain everything to you.

If you will receive home oxygen therapy, you will first need to provide an arterial blood gas sample. This blood test is taken from a vessel on the inside of your wrist. Using the results, your healthcare provider can determine exactly how much supplemental oxygen you need and when you should use it.

If a child is going to receive treatment, you as a caregiver can help prepare your child for the healthcare visit and explain what will happen in an age-appropriate way.

What to Expect During the Assessment

Your doctor will conduct a comprehensive evaluation before prescribing home oxygen therapy. This typically includes:

• Medical history review: Discussion of your respiratory condition, symptoms, and how they affect your daily life
• Physical examination: Listening to your lungs and heart, checking for signs of oxygen deficiency
• Arterial blood gas test: Measures oxygen and carbon dioxide levels in your blood
• Pulse oximetry: Non-invasive monitoring of blood oxygen saturation
• Six-minute walk test: Measures oxygen levels during exercise to determine if you need oxygen during activity
• Sleep study: May be recommended if nighttime oxygen levels are a concern

How Does Oxygen Therapy Affect Daily Life?

Oxygen therapy requires some lifestyle adjustments but most patients maintain active, fulfilling lives. Key considerations include planning for portable oxygen during outings, following safety precautions, maintaining regular follow-up appointments, and communicating needs to family, employers, and travel providers.

Living with oxygen therapy does require some adjustments, but most patients find they can continue most of their normal activities. Modern portable oxygen equipment has made it easier than ever to stay active and mobile while receiving treatment.

Staying Active

Physical activity remains important even when using oxygen therapy. In fact, exercise can improve your respiratory function and overall health. Work with your healthcare team to develop an appropriate exercise program. Your doctor may prescribe a higher oxygen flow rate during physical activity to meet your increased oxygen needs.

Portable oxygen concentrators have made outdoor activities, shopping, visiting friends, and even traveling much more accessible for oxygen-dependent patients. Plan ahead for outings by ensuring you have adequate oxygen supply and backup batteries if using a portable concentrator.

Travel Considerations

Traveling with oxygen requires advance planning:

• Air travel: Airlines require advance notice and documentation. Most allow FAA-approved portable oxygen concentrators. Notify the airline at least 48-72 hours before your flight.
• Road trips: Never store oxygen cylinders in a hot car trunk. Bring extra supplies and know locations of oxygen suppliers along your route.
• Cruises and trains: Contact the provider well in advance to understand their policies and make arrangements.
• Medical documentation: Carry a letter from your doctor describing your oxygen needs, especially for international travel.

Social and Emotional Aspects

Some patients initially feel self-conscious about using oxygen equipment in public. Remember that oxygen therapy is a medical treatment that helps you live better, just like glasses help people see. Most people are understanding and supportive. Connecting with support groups, either in person or online, can help you share experiences and coping strategies with others in similar situations.