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Your 14 Most Common Questions About Oxygen
and Answers from Lung Experts

This is general information and not intended as medical advice. If you have questions about your own oxygen needs, show this information to your doctor and talk with him or her about what’s best for you. Many thanks to Dr. Steven Kraker, Dr. Frank Adams, Dr. Robert (Sandy) Sandhaus, and Respiratory Therapist Helen Sorenson for their time and expertise in answering these questions. Answers are noted with the initials of each expert.

1. What is a normal blood oxygen level?
2. I am so short of breath. Why can’t I have oxygen?
3. I am not short of breath. Why must I use the oxygen?
4. Can it hurt me if I don’t have enough oxygen?
5. If I start on oxygen, won’t I get addicted to it?
6. Can too much oxygen hurt me?
7. I am on oxygen now. Why can’t I breathe any better?
8. Can I use my oxygen just when I am in the privacy of my own home and not when I go out shopping, to the movies or out to dinner?
9. What about oxygen at night? If I use it during the night when I sleep, will it carry over into the day?
10. Can oxygen cure me?
11. I have heard there are different types of oxygen and different ways to administer oxygen. What’s best for me?
12. I have heard there is something where you get oxygen through a little tube that goes through your neck into your windpipe. Is that for me?
13. Can oxygen into my nose get in even when I have clogged sinuses?
14. How long can my oxygen tubing be at home before the oxygen reaching me becomes less effective?


1. What is a normal blood oxygen level?
FA: Oxygen levels are commonly measured by two techniques. The first is a blood gas in which a blood sample is taken directly from an artery. This is the most accurate assessment of oxygen. The normal oxygen level using this technique is 80-100 (mmHg). The second technique is bloodless [and painless] and is called pulse oximetry. The result here is not a direct measurement of oxygen but rather represents the percentage of hemoglobin that is saturated with oxygen. Hemoglobin is a protein in the blood that carries oxygen to the tissues. A light sensor is used which is commonly placed on a fingertip. Pulse oximetry is not as accurate as a blood gas and can be influenced by temperature and circulation. The normal oxygen saturation is 95-100%.


2. I am so short of breath. Why can’t I have oxygen?
SK: Believe it or not, in many cases you really cannot tell when you need or don’t need oxygen.  Many things contribute to shortness of breath, and though it is commonly believed by the lay person that shortness of breath means you need oxygen, that is not always the case.  The converse is also true.  Patients with significant lung disease who have chronically low blood oxygen levels sometimes refuse to use oxygen because they “don’t feel short of breath.” 
For an accurate assessment of who needs oxygen and who doesn’t we must rely on measured blood levels. This is done directly on blood drawn through a needle from an artery or indirectly by a simple device called an oximeter, which can accurately measure your blood oxygen level through your finger or your ear lobe. There are criteria that doctors use to determine who does and does not need oxygen, whether that be part time or 24-hours daily. These criteria are well established in the medical literature and are also adhered to by insurance companies in determine whether they will pay for prescribed oxygen. 
You can be quite short of breath and yet have an entirely normal blood oxygen level. In that case all of the oxygen we could possibly give is not going to affect your shortness of breath. There are other factors involved in that situation which must be treated in order to improve your shortness of breath.


3. I am not short of breath. Why must I use the oxygen?
SK: Even patients who are not short of breath but yet have low blood oxygen levels can benefit from oxygen therapy in terms of quality of life and better functioning of important organs such as the brain, the heart, and the kidneys. In order to know whether you need oxygen or not your doctor needs to do some testing. If the testing does not indicate the need for oxygen, then attention needs to be focused on other contributing causes for your shortness of breath. Even though you may not qualify for oxygen at one time, it may be necessary to follow up your blood oxygen levels periodically (every 6 to 12 months) to determine if at some point in the future you may require oxygen therapy.


4. Can it hurt me if I don’t have enough oxygen?
RS: If you need supplemental oxygen, not getting enough oxygen to raise your blood levels of oxygen to an appropriate level can have very serious long term effects. Too little oxygen causes the blood vessels in the lungs to constrict making it more difficult for the heart to pump blood through the lungs. As a result, the pressure in the blood vessels feeding the lungs can rise, a condition known as Pulmonary Hypertension. If this goes on long enough the right side of the heart, the side that sends blood to the lungs, can fail, giving you a condition called right heart failure or Cor Pulmonale. In addition, if you don't have sufficient oxygen delivered to the tissues of the body, they can't function as they should. The organs most affected by low oxygen, in addition to the heart, are the muscles and the brain.


5. If I start on oxygen, won’t I get addicted to it?
SK: No, this is a myth. We have all essentially been “addicted” to oxygen since birth. We can’t live without it. The air we breathe is approximately 21% oxygen. When a patient is started on supplemental oxygen they are often put on something in the range of 24 to 30% oxygen, so it is just a little more than is in the usual air you breathe. Using supplemental oxygen does not make you dependent on it anymore than you have already been dependent on it since your first breath. It is just that with lung disease you may need a little bit more oxygen going into your lungs in order to get an adequate amount through your diseased lungs into your blood stream.
Using supplemental oxygen does not result in increasing demand for oxygen. The increased need is simply related to the progression of your underlying lung disease. Often patients who need oxygen find that as years go by and their lung disease gradually worsens that it takes more oxygen to get the same blood level. This is not because they were started on supplemental oxygen. It is merely because the disease has progressed (as is the natural course of many lung diseases). Often times patients feel that oxygen may be addictive because once they are started on supplemental oxygen they “can never get off it.” That is not because they have used the oxygen. It is just, again, related to their underlying disease. If the underlying lung disease is significant enough that oxygen is required in the first place, oxygen is likely going to always be required.
Sometimes, when people are right on the verge of needing oxygen, but not quite needing it on an everyday basis, they may come to need oxygen temporarily during an acute illness. This is something that can happen when a person is near the need for continuous oxygen therapy and with an acute illness their body will be stressed enough to require oxygen temporarily. Then after recovery their oxygen level may be back up and they can come off oxygen again. Sometimes an acute illness will be the last straw that causes you to need supplemental oxygen from that point on.
If your doctor feels you need to use oxygen, you should use it without fear of it causing dependence. Studies show that if you meet the criteria for needing oxygen and use it according to your doctor’s prescription that you will survive better and longer than a similar patient with a similar disease who chooses not to use oxygen.


6. Can too much oxygen hurt me?
SK: You should consider oxygen as a medication. Accordingly it should be treated like any other drug prescribed, that is, it should be used in appropriate doses. Just because some is good, it doesn't mean more oxygen is necessarily better. You should rely on the advice of your doctor who knows your particular case. 
Some lung diseases require a certain level of supplemental oxygen when the patient is at rest, but more oxygen is needed during times of exertion. Other lung diseases require a set amount of supplemental oxygen on a continuous basis, and increasing the dosage beyond the prescribed amount could be detrimental. You will have to discuss your own individual situation with your doctor to determine what is best for you.
Under some circumstances it can be detrimental to increase your own oxygen without consulting your doctor, just as if you increased your own heart medicine, blood pressure medicine, or diabetes medicine without consulting your doctor. Again, I think the best way to go about it is to think of your oxygen like another drug prescription and to follow the specific instructions very carefully just as you would with any of your other medicines.

RS:  There are some very specific situations in which it can be harmful to be on too much oxygen. However, for most people with chronic obstructive lung disease or COPD who receive oxygen through a nasal cannula, the answer is no, too much oxygen won't hurt you. Using too much oxygen is wasteful and can cause dryness and other discomforts.
So what are the situations in which too much oxygen can be harmful? The brain regulates breathing based on the amount of carbon dioxide in the blood. Some individuals with very severe COPD retain carbon dioxide in their blood and the brain begins to then regulate breathing based on the amount of oxygen in the blood. Giving such a person too much oxygen can actually turn off their drive to breathe and cause life threatening respiratory arrest. Therefore, people with very severe COPD should check with their
healthcare provider about whether they are at risk for this type of reaction to too much oxygen. 
There are two other situations in which too much oxygen can be harmful. The first is giving high flow oxygen to newborn babies, which can cause blindness. The second is giving 100% oxygen to someone for a very long time, usually through a tube into the windpipe attached to a breathing machine or ventilator. Receiving very high amounts of oxygen over many days in this manner can injure lung cells.


7. I am on oxygen now. Why can’t I breathe any better?
HS: This is a question we hear all the time. It might make sense that if your O2 (oxygen) levels are fine, all is right with the world, but that is not always the case. Dyspnea, or the sensation of difficult breathing does not always correlate well with the amount of oxygen (O2) in the blood - so oxygen levels may be fine, but breathing is hard.
When O2 levels are okay and you may feel like you "can't breathe," your dyspnea may be caused by anxiety (often caused by the feeling of not being able to breathe). It’s a vicious cycle. This is where pursed lip breathing is most useful, because is slows down breathing, relaxes you and often makes breathing easier. Another hint to decrease the sensation of difficult breathing is to sit in front of a fan - cool air facial stimulation decreases the sensation of dyspnea. Pulmonary rehabilitation patients tell me time and time again that the most important thing they learn from rehab is how to breathe correctly.


8. Can I use my oxygen just when I am in the privacy of my own home and not when I go out shopping, to the movies or out to dinner?
SK: Using supplemental oxygen is sometimes inconvenient or embarrassing for patients and this leads to the temptation to “use it only when I need it.” Again I would refer you to what we covered above and that is that you really can’t tell when you need oxygen and when you don’t unless your blood oxygen levels are being measured. Studies show that if you meet the criteria for continuous oxygen use, using it less than 18 hours a day is probably equivalent to using none at all. If your doctor prescribes 24-hour daily oxygen therapy you should try to use it as close to 24 hours a day as practical. Of course there are times you may need to take it off, when you shave or put on make-up or do other daily hygiene. This is not harmful for short periods of time. If you have any questions about this, it is a good idea to go over them with your doctor, pulmonary rehabilitation nurse, or respiratory therapist.


9. What about oxygen at night? If I use it during the night when I sleep, will it carry over into the day?
SK: Occasionally patients need oxygen only at night while asleep. Other patients may only need oxygen part of the day, but usually this is with any type of exertion such as walking or getting out and doing errands, etc. If your doctor determines from testing that you do not need oxygen 24 hours a day, it will usually be necessary either at night during sleep or just when you are up and active – out doing errands or some of the activities we talked about above. Often in this situation the only time you really don’t need supplemental oxygen is when you are sitting quietly resting at home reading a book or watching television. Human nature says that is the time you would like to be using your oxygen but ironically you really need it most when you are out and about.

RS: The oxygen that gets into your blood by using supplemental oxygen leaves your system within several minutes after removing your cannula. Therefore, although the oxygen you use during the night can have many long-term beneficial effects, the oxygen itself is gone from your system fairly soon after you turn off the oxygen tank or concentrator. Many patients only need oxygen when they sleep and their oxygen levels are fine without supplemental oxygen during the day. But if you need oxygen both at night and during the day, using it only at night, while better than not using oxygen at all, is not sufficient to keep you well oxygenated during the day.


10. Can oxygen cure me?
SK: No. Your oxygen does not treat your underlying lung disease. It just helps to fulfill needs that your diseased lungs cannot manage on their own. It is helping you to do a little better with what you have, but it can’t improve your lung function. It is kind of like having to wear glasses because your eyes aren't entirely normal. Wearing glasses doesn’t fix your eye problem. They just help your eyes to see better. If you take your glasses off, your eye problem is still there and you can’t see very well. The same is true for your oxygen. It just helps you do a little better with the lungs you have. Your lungs are still the way they were. Your body cannot store oxygen, so if you take your oxygen off, your blood oxygen level will go back down again within minutes.


11. I have heard there are different types of oxygen and different ways to administer oxygen.  What’s best for me?
SK: Oxygen is oxygen and whether you use liquid oxygen tanks of gaseous oxygen or a device called an oxygen concentrator, it is individualized for each patient depending on their needs. You can get excellent treatment with supplemental oxygen by any of the types of oxygen just mentioned. Liquid oxygen is just gaseous oxygen compressed into a much smaller volume so that it becomes liquid. As it is allowed to escape from its container into your oxygen tubing it becomes gaseous oxygen the same as you would get from a simple oxygen tank. For patients who are more active and mobile, liquid oxygen can sometimes be a nice alternative because they can be out and about for a longer time using a smaller sized tank.
An oxygen concentrator is good for patients who are fairly sedentary and don’t get out much. An oxygen concentrator takes oxygen from the air in a way similar to how a dehumidifier takes water from the air. Just like the water from your dehumidifier runs out through a hose into a drain, the oxygen from your oxygen concentrator runs through the tubing into your nose at a set flow rate prescribed by your doctor. The device runs on electricity in your home so you usually need to have some spare oxygen tanks in case there is a power outage.
Depending on your prescribed oxygen flow rate, a small portable tank may last you up to a few hours. Some patients like to get out more, sometimes for several hours at a time, and don't want to have to carry extra tanks with them. These patients might benefit from an oxygen conserving device. Usually these devices give you oxygen only every other, every third, or every fourth breath depending on how they are programmed. By extending the length of time you can go on a set amount of oxygen, you are actually using up less oxygen per minute. In some cases, this can be sufficient, but in other cases this is not adequate. Your doctor can test you to see if a conserving device is right for you.
The message is that oxygen is oxygen whether it is liquid, gaseous, or from a concentrator. The dose you need is whatever your doctor has determined is sufficient to maintain a normal blood oxygen level during your usual normal daily activities at home and away.


12. I have heard there is something where you get oxygen through a little tube that goes through your neck into your windpipe.  Is that for me?
SK: What you are referring to is called transtracheal oxygen therapy. It is not a tracheostomy. It is a very small, soft, plastic tube that passes through the skin of your neck just below your Adam’s apple and enters directly into your trachea or windpipe.  This method of giving oxygen is used by patients who have had trouble with nasal or sinus problems from nasal oxygen, or by patients who get sores or ulcers from the oxygen tubing. It is also recommended for some patients who need so much oxygen that it is impractical to give it through the nose. You can get by on about half as much oxygen if it is given directly into the trachea as opposed to taking it into the nose. Some of the oxygen that goes into your nose unavoidably just escapes into the atmosphere.
The transtracheal oxygen catheter is not for all people who need oxygen. It does require some special care and you have to be able to do this care yourself on at least a daily basis, sometimes more. You still have to have a nasal cannula for oxygen to use when you are removing your transtracheal catheter and cleaning it, or for emergencies if your transtracheal catheter should come out. If you are wondering whether you are a candidate for transtracheal oxygen you should ask your doctor.


13. Can oxygen into my nose get in even when I have clogged sinuses?
HS: That depends on the degree of obstruction/sinus congestion.  If the nasal passages are completely swollen/blocked, a cannula might not be as effective but if your sinuses are congested a little, you are likely breathing more through your mouth, then the oxygen going into the nasal passages will be pulled into the lungs by the air coming in through the mouth. I have seen patients put their cannula in their mouth, but that does not usually make the delivery of oxygen to the lungs any more effective.


14. How long can my oxygen tubing be at home before the oxygen reaching me becomes less effective?
HS: The length of the oxygen tubing should not affect the liter flow of oxygen being delivered. It just may take a little longer for the oxygen to get to you initially — like when it is first turned on — but once it is flowing, it should remain constant. Even though oxygen is a gas, we have to think of it in terms of being a liquid — if the pressure at the tank remains constant (which it does until the tank has less than 500 psi), the liter flow, 2 LPM (liters per minute), 3 LPM, etc. will remain constant. Think in terms of a garden hose — if the pressure/flow of water coming out of the faucet is constant, regardless of the length of the hose, the same amount of water will exit the other end. The only thing that may affect oxygen delivery is if there is an occlusion/obstruction in the tubing.


© Copyright 2012, Jane M. Martin, CRT


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