Home Oxygen Therapy
The aim of home oxygen therapy is to increase the levels of oxygen in the blood, relax the blood vessels in the lungs and to avoid the long term conditions that chronic low oxygen levels can cause. Home oxygen therapy has been proven to improve quality of life, general well-being and the longevity of people with Chronic Obstructive Pulmonary Disease (COPD).
Oxygen is essential for life. Sometimes in lung disease, the body has trouble delivering enough oxygen into the blood where it is carried to our organs and tissues. In these cases, home oxygen can increase the level of oxygen in the blood, improving function of the whole body.
In Australia to be eligible for home oxygen therapy funded through the Medical Aid Subsidy Scheme (MASS) you require a thoracic physician review. As part of this assessment you will require an arterial blood gas (ABG) measurement on room air.
Home oxygen therapy is for people who have low levels of oxygen in their blood, due to a lung or heart disease. People who may need oxygen at home include those with chronic obstructive pulmonary disease (COPD), alpha 1 antitrypsin deficiency, pulmonary hypertension, heart failure, severe angina, cystic fibrosis and lung cancer.
An oxygen concentrator (see image below) is the most common method of providing oxygen. The air that we breathe is made up of oxygen and nitrogen. A concentrator is an electronic pump that filters out the nitrogen and supplies oxygen through tubing. Often electricity costs for running the concentrator can be subsidized.
Oxygen can also be provided via pre-filled cylinders - these are more expensive and need to continually be replaced.
Supplementary (portable or ambulatory) oxygen therapy (in addition to fixed or domiciliary oxygen therapy) is a necessity for active patients who leave their homes and for daily activities. Although ambulatory oxygen therapy is prescribed for such patients little is known about the effectiveness of long term ambulatory oxygen therapy in such situations.
Will I have to use the oxygen all the time?Everyone is different and your doctor will give you a prescription outlining exactly how long and how often you need to use the oxygen. You will be given a flow-rate that your oxygen will be set to (usually between 1 and 4 Litres per minute) and a recommended number of hours per day during which the oxygen should be used. It is important that you follow your prescription to get the maximum benefit from having home oxygen. From time to time, your doctor will assess your oxygen prescription and may change it depending on how you are going.
Oxygen and Sleep
Some patients with COPD who desaturate and drop their oxygen levels at night may also have associated obstructive sleep apnoea syndrome (OSAS). Risk factors include obesity, thyroid disease, cardiac disease, and diabetes mellitus. OSAS may also have carbon dioxide (CO2) retention which will influence the safe amount of oxygen that will be prescribed.
If suspected of OSAS a diagnostic sleep study is recommended as often oxygen alone is not indicated. Treatment may require continuous positive airway pressure (CPAP) with or without supplemental oxygen.
When the arterial oxygen tension (PaO2) is 55mmHg or less (or 59mmHg or less when conditions such as cor pulmonale, pulmonary hypertension or polycythaemia are present).
- In remote areas, when arterial blood gas estimations are unavailable, hypoxaemia must be demonstrated by oximetry indicating an oxygen saturation of 85% or less (or 90% or less when conditions such as cor pulmonale, pulmonary hypertension or polycythaemia are present).
- In all cases, applicants should be on maximum medical treatment. Arterial blood gas estimations (or oximetry measurements in remote areas only), should be obtained after the condition is considered to be stable.
- The above measurements are required for both the initial application and the first (four month) reapplication. Clinical assessment only (without measurements) is required for subsequent annual reapplications.
For more information on Home Oxygen Therapy see these links: