The air we breathe at sea level contains 21 per cent oxygen – a gas vital to all the cells in our bodies. People with severe lung problems may suffer from low oxygen levels in their blood. The best way to treat this is to identify the reason for low oxygen levels and then treat the problem causing it.
Breathing in air with a higher concentration of oxygen can be used to correct a low oxygen level in the blood.
If you feel breathless and tired, particularly when moving around, you may have low blood oxygen levels. However, there are other reasons for breathlessness and unless you have low oxygen levels, oxygen treatment will not help. Special tests will show whether you have low oxygen levels and whether oxygen treatment will help.
Who needs oxygen treatment?
Oxygen treatment is not helpful for everyone with lung problems. You should see a respiratory specialist, who will assess whether extra oxygen is a useful treatment for your condition.
If you are already on oxygen and have never been assessed, ask your GP to refer you to a specialist. The specialist will assess why you are breathless and check whether you have low oxygen levels. The amount of oxygen in your blood is measured by putting a peg-like device called an oximeter on your finger, or by doing a blood test. The specialist will organise oxygen for you if you need it. They should also review all other aspects of your treatment.
How is the treatment delivered?
Oxygen can be delivered in different ways.
You could have:
- An oxygen concentrator – a machine which extracts oxygen from the air.
- Oxygen cylinders – these can be large or small and contain oxygen as a gas.
- Liquid oxygen – this comes in a container and is breathed in as a gas.
All of these types of oxygen systems are available on the NHS, once you have been assessed. Equipment must be used according to the manufacturer’s safety instructions to avoid a fire risk. No one should smoke near oxygen or use oxygen near a naked flame of any sort (for example, you should not use oxygen while cooking with gas). Some hand creams and alcohol gels are not suitable for use alongside oxygen, since they may be flammable.
It is also important to remember that oxygen is a drug – too much oxygen can be dangerous. It is dangerous for you to alter the oxygen flow rate your equipment provides or change the type of mask you use (unless instructed to do so by your specialist team). It has been prescribed for you after a very careful assessment.
Oxygen concentrators
After thorough assessment by your specialist team, you may be advised to use oxygen every day and this will usually be from an oxygen concentrator. This type of treatment is known as long-term oxygen therapy (LTOT) and, for adults, is usually recommended for at least 15 hours a day. This is best achieved by using oxygen overnight and for several hours during the day.
It is important to understand that you will not get any long-term benefit from oxygen if you either continue to smoke or if you use the oxygen for less than 15 hours a day.
The oxygen concentrator is a machine, about the size of a bedside table, that plugs in to your ordinary household electricity supply. It extracts oxygen from room air and delivers it to you by either plastic tubing to a nasal cannula (short plastic tubes that fit into each nostril) or by a face mask. Long tubing can also be fixed around the floor or skirting board, with outlets upstairs and downstairs, so that you can have oxygen around the house.
Rooms where you have an oxygen concentrator should be well ventilated. And don’t worry, there will be plenty of oxygen left in the room for others to breathe!
If you are prescribed an oxygen concentrator, your doctor or health care professional will complete an order form describing your oxygen needs. This Home Oxygen Order Form (HOOF), is sent to the contractor providing oxygen in your area. You will need to sign permission for your medical and contact details to be shared with the contractor. The company will then supply all the equipment you need to your home. An engineer will install the concentrator and explain to you and/or a friend or relative how to use it.
The supplier of your oxygen service will reimburse money towards your electricity bill to pay for the supply that the concentrator uses.
A ‘back-up’ cylinder of oxygen is also provided. The engineer will visit regularly to make sure the concentrator is working correctly.
Occasionally the oxygen treatment causes a dry, sore nose. Do not use Vaseline or any petroleum-based product to relieve this, since they can be flammable. Instead, ask your health care professional or pharmacist to advise you.
Oxygen cylinders
Oxygen cylinders contain compressed oxygen. They are provided with tubing and a nasal cannula or a face mask, delivered to your home and replaced when empty. They provide oxygen for variable lengths of time, up to eight hours, depending on the size of the cylinder and the flow rate of oxygen you have been prescribed. These cylinders are not suitable for LTOT. They are generally used for emergencies or for back-up.
Portable (or ambulatory) oxygen
Your specialist respiratory team may assess you for portable or ambulatory oxygen to see whether using oxygen when you exert yourself is helpful. If you are already on LTOT you may need to use oxygen when you go out. If so, your specialist and oxygen supplier will advise on the best type for you.
- Portable oxygen cylinders
These oxygen cylinders weigh about 2-3kg (6-7lb) and come with a carrying case. The oxygen in them lasts for about three hours (depending on the flow rate). As with any oxygen equipment, portable cylinders must be used according to the manufacturer’s safety instructions to avoid a fire risk.
- Conserving devices
A conserving device, attached to a portable oxygen cylinder, can make the three-hour supply last longer by giving you a pulse of oxygen only when you breathe in. Although this makes the oxygen last longer, it is not suitable for everyone as it cannot supply high levels of oxygen. Conservers are not usually suitable for children. Your health care professional can tell you whether or not this device is suitable for you.
Liquid oxygen
If you use portable oxygen a lot, or if you need such high flows that your cylinders do not last long, your specialist respiratory team, in discussion with the company that provides home oxygen, may recommend that you use liquid oxygen. This is delivered and decanted into a tank in your home. This tank will be replaced by your supplier when it is nearly empty.
Liquid oxygen tanks must be housed in a very well-ventilated room, garage or shed, ensuring that there are no items around likely to catch fire. The tanks are used to fill portable oxygen cylinders, which contain a longer supply of oxygen than the usual portable cylinders.
It is your responsibility to inform your oxygen supplier when you need replacement oxygen cylinders or liquid oxygen tanks.
Smoking and oxygen
You should never smoke when using oxygen, since the carbon monoxide in the smoke reduces the amount of oxygen which your blood is able to carry around the body. This makes the oxygen treatment ineffective. Oxygen also helps combustion and so it is vital that there is no smoking around oxygen. There is a risk of facial burns and house fires if someone smokes in the home when the oxygen supply is turned on.
If you continue to smoke while using oxygen, a risk assessment will be undertaken and a discussion may be had about the removal of your oxygen supply.
Ask your respiratory team for advice on how to quit, or see below for details of BLF information on stopping smoking.
Holidays and travels
Discuss travel plans, especially those that involve flying, with your respiratory specialist or GP before booking your holiday. With planning, oxygen can be arranged at holiday destinations in the UK using the NHS system.
If you are travelling abroad, your respiratory specialist or oxygen supplier will be able to provide you with contact information for companies that provide oxygen therapy outside the UK. However, you will need to organise and pay for this.
Further information
The BLF Helpline, 08458 50 50 20, can provide advice on oxygen treatment and lung disease. It is open from 10am to 6pm, Monday to Friday and calls are charged at a local rate.
The BLF also produces a range of information about lung disease. It is available to read at lunguk.org/publications. Publications can be ordered free of charge from our online shop at www.blfgifts.com or by calling the BLF Helpline.
The following may be of interest to you:
- Living with COPD (BK3)
- Stopping smoking (BK10)
Also ask your health care professional about the BLF’s Self-management pack.
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Code: FL32 Version: 1.0
Last medically reviewed: June 2011
Due for medical review: June 2013
For references call 020 7688 5555
