There are many diseases and disabilities that can decrease lung function and ultimately require the use of supplemental oxygen (O2). The U.S. National Library of Medicine lists chronic obstructive pulmonary disorder (COPD), pneumonia, asthma, late-stage heart failure, cystic fibrosis and sleep apnea as common conditions that necessitate oxygen therapy.
If you are caring for someone who is chronically ill and has been prescribed oxygen, it is likely you will see an improvement in their activity level, alertness and outlook once treatment begins. However, it’s important to be sure they are using the right equipment and that all necessary safety precautions are taken.
How to Pay for Supplemental Oxygen
Only a doctor (typically a pulmonologist) can prescribe durable medical equipment (DME) including oxygen concentrators and tanks. Such prescribed oxygen equipment and accessories are rented and covered by Medicare Part B, but make sure that the doctor has documented the need for oxygen in your loved one’s medical record, or else their claim may be denied.
In addition to meeting Medicare’s criteria for medical need, a senior must require oxygen on an ongoing basis and must use it in their home. Medicare may also pay for a humidifier for patients who require one in conjunction with their therapy. The degree of coverage can vary with private insurance plans, so remember to check the details of your loved one’s policy. Keep in mind that any electricity needed to operate the equipment is paid for out of pocket, though.
Home and Portable Oxygen Options
Oxygen therapy may be administered from a tank of compressed gas, a tank of cold liquid or concentrated gas taken from the air. Each of these options varies in size, weight and capacity, so one of these is sure to fit into your loved one’s routine.
Most people associate oxygen usage with compressed gas tanks. These come in a variety of sizes, are relatively heavy and must remain upright. They can be used to fill portable tanks and are good to have on hand in case of a power failure when using an electric-powered concentrator in the home. Some compressed O2 containers are small enough to carry in a backpack or wheel around on a cart.
Another option is liquid O2. Since the liquid form takes up only a fraction of the space that compressed gas does, these tanks hold more and weigh less. Like compressed tanks, they can be used to fill portable tanks, but note that liquid oxygen is more expensive and has a shorter shelf life.
An oxygen concentrator takes air from the environment, filters out other gases, and compresses and stores O2. Concentrators are powered by plugging into an electrical outlet or using rechargeable batteries. A standard flow concentrator can deliver up to 5 liters per minute (L/min), while high flow concentrators can deliver up to 10 L/min. Concentrated oxygen is one of the most economical options, but, as stated above, running one of these machines will affect a patient’s electricity usage and costs.
Certain oxygen devices can release O2 to the user through either pulse doses or continuous flow. Pulse dose technology delivers oxygen based on breathing and inhalation rates, whereas continuous flow is delivered at a constant rate whether it is inhaled by the user or not. Pulse dose allows for more efficient use of the supply but requires a certain degree of lung function to initiate each pulse.
Methods of Administering Supplemental Oxygen
Oxygen is delivered for use by either a nasal cannula or a face mask. Face masks are typically utilized for shorter periods of therapy. Nasal cannulas are the most popular option for long-term wear but can cause irritation and dry skin inside and around the nose.
Keeping these sensitive areas moisturized and minimizing inflammation is important, but never use petroleum-based lotions, creams or balms to treat these spots. Such products can cause the oxygen to ignite. Water-based moisturizers are a good choice for protecting and healing dry, chapped skin and nasal passages. Nasal cannulas can also cause skin irritation where the tubing rubs the ears, but soft foam ear protectors can be purchased to cover the tubes.
More rarely, a tracheostomy mask is used for oxygen delivery in patients who have had an opening placed in their trachea for breathing or secretion removal. A tracheostomy mask fits over a patient’s neck and stoma and administers oxygen directly into the trachea.
When we breathe, our mouth and nose filter, warm up and moisten the air that is inhaled. Seniors with artificial airways require additional equipment, such as a humidifier, to make up for these mechanisms and keep their respiratory system healthy. Humidifiers may also be used on other delivery systems like nasal cannulas to increase comfort and maintain respiratory tissue integrity. Your loved one’s doctor and respiratory therapist can recommend the right mix of equipment that will improve their oxygen saturation levels and maximize comfort.
Monitoring Oxygen Saturation Levels
Pulse oximeters are available over the counter without a prescription and can be useful in monitoring the blood oxygen levels of people with more severe respiratory issues who experience bouts of extreme shortness of breath. This tool uses a painless light probe to measure both O2 concentration and heart rate.
Additional tests may be required for seniors with severe lung disease who show symptoms of oxygen and carbon dioxide imbalance. For example, a simple blood test using a sample from either a vein or an artery (or both) can be used to measure blood CO2 levels and pH. The doctor can use these results to ensure oxygen therapy is effectively treating a patient’s condition and that they are not retaining carbon dioxide, which can cause additional health issues.
Safety Precautions Associated with Home Oxygen Therapy
Oxygen is a highly flammable element. Always store O2 tanks away from heat sources and keep them upright. Never smoke while using oxygen, or when near someone using it, and keep equipment away from all open flames. Do not use electrical devices such as heating pads while undergoing therapy. Packs designed to be both heated in a microwave or cooled in a freezer can be substituted for a heating pad, just be sure to not overheat them.
Traveling with Oxygen
Oxygen therapy is meant to improve a senior’s health and quality of life, not hold them back. If you plan to travel with someone who is dependent on supplemental oxygen, make sure to clear your plans with their doctor first and obtain a written order stating their need for O2. You can usually have a prescription called in if needed, but a handwritten one will ensure your loved one can get the treatment they need in emergency situations or if the doctor is not immediately available. Locating an oxygen supplier at your destination is also highly recommended in case there is an emergency or your loved one’s equipment malfunctions.
Most major airlines require a written note from a passenger’s physician, and many restrict the portable oxygen devices that are allowed onboard. It’s best to check airline policies on oxygen therapy and then work with your loved one’s doctor and durable medical equipment provider to explore travel options. Bus, train and cruise lines also vary in their policies, but car travel should be relatively simple using a portable oxygen tank or a portable oxygen concentrator that can plug directly into the vehicle’s power outlet.
Sources: Oxygen Therapy (https://medlineplus.gov/oxygentherapy.html)