A Guide to Supplemental Oxygen Therapy

Key Takeaways

• Supplemental oxygen can benefit people with respiratory conditions like COPD and emphysema.
• There are different supplemental oxygen devices available, including portable options.
• Regularly measuring your blood oxygen level is important so your health care provider can prescribe the right dose for your needs.

Supplemental oxygen therapy is a common medical treatment for low blood oxygen (hypoxia). You may be prescribed oxygen therapy for a variety of reasons, including chronic lung conditions or if you’re recovering from surgery. Supplemental oxygen can be administered in a medical setting, or your health care provider may write you a prescription for home oxygen care.

According to the American Thoracic Society, approximately 1.5 million people in the United States need help breathing with supplemental oxygen. ^[1]Jacobs S, et al. Optimizing Home Oxygen Therapy. An Official American Thoracic Society Workshop Report. Annals of the American Thoracic Society. December 2018. Found on the internet at https://www.atsjournals.org/doi/10.1513/AnnalsATS.201809-627WS An oxygen concentrator provides extra support to complete daily tasks, travel, or stay active. If your doctor prescribes supplemental oxygen therapy, our guide can help you learn more about the benefits and device options.

Medicare covers many types of durable medical equipment including portable oxygen concentrators. Check with your provider to understand if the equipment that you’re prescribed is covered.

What does supplemental oxygen therapy do?

Supplemental oxygen therapy supports people with respiratory conditions by providing a continuous supply of oxygen to help them breathe better and keep their blood oxygen levels up. Supplemental oxygen is available through various devices. Some are larger devices meant for home use, while others are portable and can go with you outside the home.

“A well-maintained, portable oxygen tank allows individuals who need supplemental oxygen to navigate life with more confidence and strength,” said Gavin Dawson, PA-C, WEMT, Founder and Lead Instructor at Global Emergency Medics in Boulder, Colorado.

Depending on your oxygen needs, you can receive different types of oxygen therapy, like: ^[2]Shebl E, et al. Home Oxygen Therapy. StatPearls. May 29, 2023. Found on the internet at https://www.ncbi.nlm.nih.gov/books/NBK532994/

• Long-term oxygen therapy: Prescribed for people with chronic hypoxia to use at least 15 hours a day
• Ambulatory oxygen therapy: Prescribed for people who develop hypoxia during exercise
• Nocturnal oxygen therapy: Prescribed to administer oxygen overnight
• Short burst oxygen: Prescribed for brief uses of oxygen supplementation
• Palliative oxygen therapy: Prescribed to relieve breathlessness in people in advanced stages of illness

Who needs supplemental oxygen?

People undergoing surgery and in post-surgical settings often receive supplemental oxygen. Certain medical conditions may also require oxygen therapy, like: ^[3]Cleveland Clinic. Supplemental Oxygen Therapy. June 6, 2022. Found on the internet at https://my.clevelandclinic.org/health/treatments/23194-oxygen-therapy

• Altitude sickness
• Asthma
• Bronchitis
• Chronic obstructive pulmonary disease (COPD)
• COVID-19
• Cystic Fibrosis
• Emphysema
• Neurological disorders such as migraine and cluster headaches ^[4]Mo H, et al. Oxygen Therapy in Cluster Headache, Migraine, and Other Headache Disorders. Journal of Clinical Neurology. May 2022. Found on the internet at https://pubmed.ncbi.nlm.nih.gov/35589316/
• A history of heart attack
• Heart disease
• A history of heart failure
• Lung cancer and other cancers
• Lung disease
• Pneumonia

Supplemental oxygen therapy devices can be attached to other medical equipment including CPAP machines, which are used to help people with sleep apnea.

What is a healthy oxygen level?

A healthy oxygen level ranges from 95% to 100% for most people, according to the Cleveland Clinic. ^[5]Cleveland Clinic. Blood Oxygen Level. Feb 18, 2022. Found on the internet at https://my.clevelandclinic.org/health/diagnostics/22447-blood-oxygen-level But baseline oxygen levels may be lower for people with chronic lung conditions.

Your health care provider may use these tools to measure your levels:

• Pulse oximeter: A small clip placed on your fingertip that uses infrared light to painlessly measure your blood oxygen and heart rate. You can buy an oximeter for at-home use. The pulse oximeter should show blood oxygen levels between 98% and 100% in healthy individuals. ^[3]Cleveland Clinic. Supplemental Oxygen Therapy. June 6, 2022. Found on the internet at https://my.clevelandclinic.org/health/treatments/23194-oxygen-therapy
• Arterial blood gas test: A respiratory therapist draws blood to measure arterial oxygen pressure (paO2). In healthy people, paO2 is normally 80 to 100 millimeters in mercury (mm Hg). Results from this test are more accurate than what you’ll get from a pulse oximeter. ^[6]University of California San Francisco Health. The Need for Supplemental Oxygen. Found on the internet at https://www.ucsfhealth.org/education/the-need-for-supplemental-oxygen
• Lung function test: This test measures how much air you inhale and exhale. A technician places a clip on your nose and gives you a plastic mouthpiece connected to a spirometry machine, which measures how much air you can breathe into your lungs. You will place your lips tightly around the mouthpiece, take a deep breath, and blow out as hard and fast as possible. The test repeats several times to make sure the results are accurate.

You may experience the following symptoms if your oxygen level measures are lower than 95%:

• Bluish tint to fingernails or lips
• Coughing
• Confusion
• Fatigue
• Shortness of breath
• Wheezing

If your blood oxygen consistently falls below the normal range and you have any of these symptoms, seek medical care.

Types of oxygen therapy systems

Different devices offer high-flow and low-flow options, depending on the amount of oxygen you need. High-flow models provide up to 10 liters per minute (LPM), and low-flow models provide approximately 0.5 to 5 LPM. ^[7]Hardavella G, et al. Oxygen Devices and Delivery Systems. Breathe. September 2019. Found on the internet at https://breathe.ersjournals.com/content/15/3/e108 For most devices, oxygen is delivered through a nasal cannula or a face mask.

Oxygen machines

Oxygen concentrators pull air from the room, which is normally about 21% oxygen, and compress the oxygen to levels close to 100%. ^[8]COPD Foundation. Oxygen Therapy. Found on the internet at https://www.copdfoundation.org/Learn-More/I-am-a-Person-with-COPD/Oxygen-Therapy.aspx They also filter out nitrogen and impurities from the air. Home oxygen machines provide a continuous flow of oxygen to the patient. They do require a connection to a power outlet in order to function, and most are designed to stay in one place in the home.

Compressed oxygen cylinders

Compressed oxygen cylinders, also called oxygen tanks, are high-pressure containers filled with concentrated oxygen. Tanks can provide continuous or pulse delivery oxygen, depending on the regulator you use. These cylinders come in different sizes to accommodate various oxygen needs in or out of the home, and they do not require electricity to provide oxygen. Tanks do run out of oxygen and must be refilled periodically.

Liquid oxygen systems

Liquid oxygen systems use pure oxygen—which is compressed and kept at a very cold temperature, almost frozen—and convert it into gaseous, breathable air as it warms up. According to the American Lung Association, these systems are for people who need high levels of oxygen, usually 6 LPM or more. ^[9]American Lung Association. Getting Started with Liquid Oxygen. Nov. 17, 2022. Found on the internet at https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/oxygen-therapy/getting-started-with-liquid-oxygen They are available in stationary units and portable devices. Liquid storage is less expensive than gas storage and does not require electricity. Liquid oxygen evaporates if not used regularly. Stationary units must be refilled on a regular schedule, as often as weekly or bi-weekly, depending on the usage. Because of how expensive liquid oxygen systems are to service, they may not be available in all areas.

Portable oxygen concentrators

Portable oxygen concentrators (POCs) are small devices people can use for oxygen therapy on the go. They pull in the surrounding air, filter out impurities, and provide oxygen in bursts, called pulse doses, based on your breathing rate. Portable oxygen machines are lightweight, and some units come with a carrying case to make them easy to take out with you. Depending on your flow rate, they can run on rechargeable batteries for 3 to 16 hours. You can recharge them at home or in the car with a special charger. You should carry an extra battery with you, or know where you can access an electrical outlet, in case it runs out of charge while you’re out and about.

Benefits of supplemental oxygen

A supplemental oxygen supply can help keep your organs working efficiently, help you sleep better, and relieve symptoms like: ^[6]University of California San Francisco Health. The Need for Supplemental Oxygen. Found on the internet at https://www.ucsfhealth.org/education/the-need-for-supplemental-oxygen

• Shortness of breath
• Fatigue
• Dizziness
• Depression and mood disorders

Oxygen therapy can also help people live more active and enriching lives. “The body needs oxygen to stay active, which is why supplementary oxygen therapy is so important. Individuals who can go out, move around, and be social are more likely to live longer, healthier lives,” Dawson explained.

What are the side effects of supplemental oxygen?

Supplemental oxygen therapy is generally very safe, though some people may experience light side effects, like a dry or bloody nose, morning headaches, or tiredness. ^[10]National Library of Medicine. Oxygen Therapy. March 28, 2023. Found on the internet at https://medlineplus.gov/oxygentherapy.html

“Usually, a health care provider prescribes the appropriate flow rate and frequency for oxygen supplementation based on the patient’s condition,” Dawson said. “However, some may be tempted to self-regulate their oxygen intake based on how they feel, which not only hampers proper treatment but also increases the likelihood of experiencing adverse effects such as headaches, confusion, and increased sleepiness,” he added.

Ensure you adhere to the dose your provider prescribes to avoid any potential side effects.

Safety considerations

Only take the amount of supplemental oxygen your doctor prescribes. The FDA warns that taking too little oxygen can cause hypoxia and damage your heart, brain, and other essential organs. Breathing in too high of a dose can lead to lung damage. ^[11]US Food and Drug Administration. Pulse Oximeters and Oxygen Concentrators: What to Know About At-Home Oxygen Therapy. Feb. 19, 2021. Found on the internet at https://www.fda.gov/consumers/consumer-updates/pulse-oximeters-and-oxygen-concentrators-what-know-about-home-oxygen-therapy

Handle your oxygen in a safe environment. Be careful to avoid smoking or any open flames because oxygen is highly flammable. Avoid pilot stoves, hair dryers, heating pads, lit candles, and fire pits. Use water-based moisturizers on your skin and avoid vaseline-based products because they are flammable. Keep oxygen canisters in upright positions at all times. ^[12]University of California San Francisco Health. Supplemental Oxygen: Oxygen Safety. Found on the internet at https://www.ucsfhealth.org/education/supplemental-oxygen-oxygen-safety

It’s a good idea to keep a fire extinguisher in the house and to know where they are stored at places you visit. ^[11]US Food and Drug Administration. Pulse Oximeters and Oxygen Concentrators: What to Know About At-Home Oxygen Therapy. Feb. 19, 2021. Found on the internet at https://www.fda.gov/consumers/consumer-updates/pulse-oximeters-and-oxygen-concentrators-what-know-about-home-oxygen-therapy

Bottom line

Supplemental oxygen therapy is a safe and standard medical treatment for low blood oxygen. People with respiratory conditions like COPD, emphysema, and those who just underwent surgery commonly receive oxygen therapy to help them breathe easier.

Depending on your lifestyle and oxygen flow needs, you can choose from oxygen canisters, liquid oxygen systems, or home or portable oxygen concentrators. Measure your blood oxygen level regularly using a pulse oximeter at home, and contact your health care provider to ensure you receive the correct dose.

Have questions about this article? Email us at reviewsteam@ncoa.org.

Sources

1. Jacobs SS, et al. Optimizing Home Oxygen Therapy. An Official American Thoracic Society Workshop Report. American Thoracic Society. December 2018. Found on the internet at https://pubmed.ncbi.nlm.nih.gov/30499721/
2. Shebl E, et al. Home Oxygen Therapy. StatPearls. May 29, 2023. Found on the internet at https://pubmed.ncbi.nlm.nih.gov/30422587/
3. Cleveland Clinic. Supplemental Oxygen Therapy. June 6, 2022. Found on the internet at https://my.clevelandclinic.org/health/treatments/23194-oxygen-therapy
4. Mo H, et al. Oxygen Therapy in Cluster Headache, Migraine, and Other Headache Disorders. Journal of Clinical Neurology. May 2022. Found on the internet at https://pubmed.ncbi.nlm.nih.gov/35589316/
5. Cleveland Clinic. Blood Oxygen Level. Feb 18, 2022. Found on the internet at https://my.clevelandclinic.org/health/diagnostics/22447-blood-oxygen-level
6. University of California San Francisco Health. The Need for Supplemental Oxygen. Found on the internet at https://www.ucsfhealth.org/education/the-need-for-supplemental-oxygen
7. Hardavella G, et al. Oxygen Devices and Delivery Systems. Breathe. September 2019. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876135/
8. COPD Foundation. Oxygen Therapy. Found on the internet at https://www.copdfoundation.org/Learn-More/I-am-a-Person-with-COPD/Oxygen-Therapy.aspx
9. American Lung Association. Getting Started with Liquid Oxygen. Nov. 17, 2022. Found on the internet at https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/oxygen-therapy/getting-started-with-liquid-oxygen
10. National Library of Medicine. Oxygen Therapy. March 28, 2023. Found on the internet at https://medlineplus.gov/oxygentherapy.html
11. US Food and Drug Administration. Pulse Oximeters and Oxygen Concentrators: What to Know About At-Home Oxygen Therapy. Feb. 19, 2021. Found on the internet at https://www.fda.gov/consumers/consumer-updates/pulse-oximeters-and-oxygen-concentrators-what-know-about-home-oxygen-therapy
12. University of California San Francisco Health. Supplemental Oxygen: Oxygen Safety. Found on the internet at https://www.ucsfhealth.org/education/supplemental-oxygen-oxygen-safety