When Can I Stop Using Oxygen for My COPD?

Senior woman using oxygen tank at home
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Oxygen is one of 5 therapies that has been shown to prolong life in patients with COPD who have consistently low oxygen levels in their blood (called hypoxemia or hypoxia).  However, just because you may have required oxygen at one point in time, does not necessarily mean that the oxygen therapy will be required indefinitely.  In fact, many patients get started on oxygen after an admission to the hospital, and get sent home using an oxygen tank.

  What many patients don’t realize is that it may be possible that after a few days, weeks, or months that oxygen is no longer needed.  

There is no doubt that using oxygen when its appropriate has many health benefits, such as prolonging life, decreasing strain on the heart, and improving symptoms of shortness of breath. 

But, using an oxygen tank is not without risk.  First, oxygen tanks are bulky and sometimes heavy.  The tubing and equipment itself can cause a risk of falling, particularly for elderly or weakened patients. Not to mention, the tube in the nose (called a nasal cannula) can be irritating and can dry out the nasal membranes.  Perhaps the most dangerous risk is that of fire or explosion, particularly if oxygen users continue to smoke.  Oxygen tanks should never be near open flames or heat. Furthermore, oxygen is expensive, often with high copays and out of pocket expenses for patients.

 

It is for these reasons that the Choosing Wisely campaign has advocated for greater awareness about the potentially inappropriate prolonged use of oxygen.  The campaign, which is was created to advocate for reductions in unnecessary and/or unproven medical therapies, includes a helpful resource that explains the appropriate (and inappropriate) use of home oxygen prescriptions after a hospital stay.

  The campaign notes that “many people who use long-term home oxygen don’t need it”.

The following criterion are used by healthcare providers to determine whether patients should be discharged home from the hospital on oxygen. 

  • Pulse oximetry readings below 88% saturation while at rest or during exertion
  • A blood test (called an arterial blood gas) may also be done to determine if oxygen levels are below a certain level in the blood (55 mm Hg)

In addition, a walking test (called a 6 minute walk test) is typically done to determine how MUCH oxygen is required. 

Many patients go home from a hospitalization requiring oxygen, but perhaps do not need it continued once they recover and are back in their home routine.  Therefore, it is critical to return for a physicians visit on or before 90 days of discharge from the hospital.  Any physician can test whether oxygen is still required. 

To reiterate- long-term oxygen therapy HAS been shown to prolong life in patients who need it.  However, it has NOT been shown to have benefits in patients who do not meet the criterion listed above, and has risks and costs associated with it.

The bottom line:

If you are on home oxygen for COPD, make sure your physician reassesses whether you do in fact need it, recognizing that the needs of patients with COPD may change frequently over time.

Sources

Nonoyama ML, Brooks D, Guyatt GH, Goldstein RS. Effect of oxygen on health quality of life in patients with chronic obstructive pulmonary disease with transient exertional hypoxemia. Am J Respir Crit Care Med 2007;176:343-9.

Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group. Ann Intern Med 1980;93:391-8.

Macnee W. Prescription of oxygen: still problems after all these years. Am J Respir Crit Care Med 2005;172:517-8.

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