Do I Need (Supplemental) Oxygen?

Why do I need supplemental oxygen? 

There are many reasons you may need supplemental oxygen.

One is if you are not getting enough oxygen (this is called hypoxia) after a bad case of pneumonia put you in the hospital. Symptoms of hypoxia include headaches, weakness, shortness of breath, fainting, chest pain, muscle pain and lightheadedness. Supplemental oxygen will help with all those symptoms. If you were sick with pneumonia or COVID-19, supplemental oxygen may be needed in the short term, for three to six months, until your lungs heal.

If you have a history of lung disease, you may be prescribed supplemental oxygen long term. You may have COPD (a lung ventilation problem), interstitial lung disease (pulmonary fibrosis) or even heart disease that benefits from supplemental oxygen. With any of these diseases, patients can come in and describe feeling short of breath walking upstairs, walking longer distances or something that is a change in their norm. Healthcare providers often see this in long COVID patients as well. We have to think about what their baseline physiology is, and could they be at risk for low oxygen levels. If they are consistently below 89% on an oxygen saturation, that is when we really think about oxygen supplementation.

What should I expect if I decide to use supplemental oxygen? 

The best thing is many patients will feel a little or a lot more energy. They'll be able to walk further. They'll be able to accomplish their activities of daily living with more ease. They will have less muscle pain. Low oxygen levels don't just affect the lungs, it affects the brain, the muscles and the whole body. Using oxygen means the heart and body work less to accomplish the same goals.

How often should I use it? 

Studies have shown that you need to be using your supplemental oxygen 18 hours or more out of the 24-hour cycle in order to get maximum benefit. So, can you get into the shower and take a shower without it? Absolutely, if you can deal with it symptomatically. If you're passing out and you get short of breath and you can't be off it for a few minutes, then you shouldn’t take the oxygen off in the shower. But if you're able to handle taking it off for half an hour at a time, that's fine.

Will I be on supplemental oxygen for the rest of my life? 

It all depends on what is driving the low oxygen levels and if it is reversible.

There are short-term situations, such as we saw with patients who had COVID, where they would be able to wean off after three or six months. Or if it’s somebody with pulmonary hypertension and you're putting them on pulmonary vasodilators, there is the possibility they’ll wean off it.

If it's somebody with a chronic lung disease like severe COPD who needs supplemental oxygen, the damage to the lungs is not going to reverse itself so it is more likely that oxygen will be needed long term. If it's structural lung problems like interstitial lung disease, the likelihood of getting off supplemental oxygen is also low.

Are there any side-effects? Will I become dependent?

Sometimes, if the oxygen is not humidified and you have more than three or four liters a minute, it can cause dryness in the nasal passage which can cause nosebleeds. Adding a humidifier or switching to a mask can help with this.

Many patients are worried about becoming dependent on it or needing to be on it forever. But they really don't understand that if it is being suggested, it will be helpful to them. I've also seen patients with pulmonary fibrosis who get cranked up on their oxygen during pulmonary rehab and then they say that they get dependent on that higher level. Most devices are not able to maintain greater than four or six liters per minute, but if you're exercising in a pulmonary rehab facility, they have bigger tanks and patients get used to the energy that higher level gives them. Unfortunately, when you bring them back to their four to six liters, they may feel sicker for a while. That is why an open and ongoing discussion with your healthcare provider is crucial.

A note of caution about sleep apnea.

There are some patients who have significant sleep apnea and if it's undiagnosed and they're just put on oxygen without a proper evaluation, that can worsen their sleep apnea. This is why evaluating the physiology of the patient is so important. Your healthcare provider needs to determine what is driving the low oxygen and to make sure the low levels are sustained.

The issue with sleep apnea is if you have to treat it with a PAP device (a positive airway pressure device), and then assess their need for oxygen on top of that, once they're on appropriate sleep therapy. Oxygen alone will not solve sleep apnea problems, so each situation needs to be evaluated individually.

When should you talk to your doctor? 

You should consult your healthcare provider if you are feeling more fatigued and shorter of breath, and it's a change in what you’ve experienced over the past six months or a year. Pulmonary offices are well equipped to test for these low oxygen levels. But you should always let your doctor know if you are concerned.

Learn more at Lung.org/oxygen.