Your doctor may provide supplemental oxygen as a treatment option to improve your quality if life if you have pulmonary hypertension and your blood oxygen level is low (hypoxic).

Low oxygen levels in the lungs can cause the pulmonary arteries to constrict (tighten), increasing resistance and making it harder for blood to flow. Supplemental oxygen can help some patients maintain adequate oxygen levels that relax the blood vessels, allowing blood to flow easier in the lungs to improve symptoms.

Supplemental oxygen can improve your quality of life

Supplemental oxygen use is just as important as prescribed pills, inhaled or infused medications.

Understanding oxygen therapy

If you are prescribed oxygen, this means that you require a higher percentage of oxygen to maintain adequate oxygen levels in the body. Typical air at sea level is approximately 20- 21% oxygen and 78% consists of nitrogen and other gases.

The percent of oxygen in the air a person breathes is called FiO2 (fraction of inspired oxygen). Supplemental oxygen can provide approximately 24-100% oxygen depending on the source of oxygen.

The FiO2 you receive from your oxygen delivery system depends on the flow rate or liters of oxygen per minute. Historical analysis has shown that for every liter of supplemental oxygen, the FiO2 increases by 4%, although some studies suggest the percentage decreases to 2.5% when the flow is less than 5 liters per minute.

Therefore, 1 L/min flow rate can increase FiO2 to approximately 22.5-24%, 2 L/min to 26.5-28%, 3 L/min to 30.5-32%, 4 L/min to 34.5-36%, 5 L/min to 38.5-40%, and 6 L/min to 42.5-44% and so forth.

Oxygen doses

Oxygen flow rates are described in liters of oxygen per minute (L/min); and generally, range from 1-10 L/min for most patients. Your clinic will perform an oxygen titration test to determine how much oxygen is needed and when oxygen is needed. Very high oxygen flow rates can be challenging to deliver with standard equipment and can have unwanted effects such as drying and irritation on the lining of your nose and throat.

In oxygen therapy, a patient receives supplemental oxygen from tanks or cylinders, or an oxygen concentrator through a face mask or a lightweight nasal tube called a cannula. There are many different oxygen device options. Some of these devices are portable and others are meant for home use. The way you receive supplemental oxygen therapy depends on several factors, such as how much oxygen you need and what your insurance covers.

Working with your care team

If prescribed, your health care team will work to balance oxygen flow and portability depending on your medical needs and insurance coverage.

It’s important you discuss with your health care team what type of oxygen device is best for you. Talk about your needs not only at home, but also what you need when you’re exercising, traveling or otherwise exerting yourself.

Along with your prescription, your doctor will provide a certificate of medical necessity stating you require supplemental oxygen. Make sure this certificate includes exactly what you and your doctor discussed for your oxygen and mobility needs.

Next, you will have to find an oxygen supplier to provide what is in the certificate of medical necessity. Know that your oxygen supplier is not your doctor and cannot make decisions about the type of equipment you require. Only you and your doctor may do this.

Oxygen delivery devices

There are two main types of supplemental oxygen, also called modalities: gaseous and liquid. These modalities work differently and there are pros and cons with each. 

 

Gaseous oxygen is delivered by concentrating oxygen from the air and putting out nearly 100% oxygen gas.

Stationary oxygen concentrators use an electric source like a wall outlet or battery to take in regular air and separate oxygen from other gases to deliver oxygen-rich air to the user. They are well-suited to provide oxygen therapy at home but are not portable, and rely on electricity so it’s important to consider a backup oxygen system in case you lose power.

Compressed oxygen comes in a metal tank that stores oxygen under pressure. These tanks come in a range of sizes. Most are heavy and difficult to transport, typically requiring a wheeled cart. Compressed oxygen tanks are not allowed on airplanes. Discuss with your provider whether to fill them at home yourself or have them delivered as full tanks from a durable medical equipment company.

Transfill systems, sometimes called home-fill systems, are used to refill compressed oxygen cylinders so you don’t have to call your DME company for replacements. Transfill units fill at 2000 or 3000 psi (pounds per square inch). Units with higher pressure capabilities can fit more oxygen into the same size of cylinder.

This system helps you move around easier outside and inside your home because you are in control of filling your own tanks. The entire system can be moved if you need to leave your home for extended periods, like relocating to a summer home.

Portable oxygen concentrators take in regular air and filter out other gases to deliver oxygen. Most run on batteries and are small enough to be carried in a backpack. Many are pulse flow, meaning they deliver a pulse of oxygen when you breathe in, rather than a continuous flow.

These devices can’t provide high-liter flows for individuals who need more oxygen. Keep in mind the liter flow settings on a portable oxygen concentrator are not the same as continuous flow devices. Pulse dose setting numbers are specific to the device, and they can differ between manufacturers. Only certain concentrator models are approved for use on airplanes. Discuss the model you plan to use with your care team to make sure it will meet your needs.

Liquid oxygen has been super-cooled until the gas becomes a liquid; then it is stored in a large metal reservoir tank. When exposed to air, the oxygenit changes back to a gas. The reservoir supplies oxygen while at home, and smaller portable containers can also be filled from it. Your DME provider must send a specialized delivery truck to refill the reservoir on a regular basis.

Portable liquid oxygen containers are capable of providing high continuous flow (4->10 Liters/min) and lighter weight, and are therefore far more manageable for patients. Because these containers gradually lose oxygen to evaporation even when not in use, portable units should be filled immediately before use.

One advantage to the liquid oxygen modality is that it’s not dependent on electricity, unlike a stationary concentrator. This means your oxygen use will not add to your utility bill, and if the power goes out you will continue to have oxygen while the reservoir lasts. However, in many areas of the U.S. it has become very difficult to obtain liquid oxygen. Check with suppliers in your area before deciding on liquid oxygen to make sure it is available.

 

Continuous positive airway pressure (CPAP) machine 

The CPAP is used with a mask and provides air pressure for people with sleep apnea to keep the airways open during sleep. It can be used with oxygen but does not provide additional oxygen. You will need a separate prescription to use oxygen with your CPAP machine. 

Nasal cannulas 

Nasal cannulas are tubes that deliver oxygen from your device to your nose. There are cannulas designed to work with oxygen flows over six liters per minute. They tend to be thicker and are typically only used in hospitals 

Oxygen conservers 

These devices regulate the flow of oxygen between a patient and an oxygen cylinder.  

  • A conserving device works by releasing oxygen on demand only when a patient inhales.  
  • The reservoir option captures oxygen temporarily and must be used with continuous flow oxygen.  

Oxygen cannula conserver – pendant or mustache style oxymizer 

An oxymizer is a nasal cannula with an attached reservoir to hold the oxygen that would typically be wasted during exhalation, allowing more oxygen to be available when you breathe in. It comes in two styles, the pendant version with a reservoir that can be worn under a shirt, or the mustache version with the reservoir built in as part of the nasal cannula.  

Oxymizers are helpful for people with high flow needs and those who can’t tolerate other conserving devices. It is compatible with a variety of oxygen sources and is an alternative to an oxygen mask that allows the user to eat, drink, and talk comfortably. It should be replaced every three weeks or as necessary. 

Simple oxygen masks

Simple oxygen masks deliver oxygen to the nose and mouth.

Insurance coverage

Follow up with your oxygen distributor and insurance company so that you know which tests are required by your insurance provider and how often these need to be completed. Insurance may dictate how frequently you need to be tested. 

Insurance coverage

Oxygen