While many patients, relatives and even healthcare professionals view oxygen therapy as ‘harmless and helpful’, the reality is quite different.
“I’m breathless. I always get given oxygen when I come into hospital. I’m sure if I had a bit of oxygen at home I’d feel better and keep out of hospital.”
I hear this again and again, not just from patients and relatives who, understandably, associate relief of symptoms with oxygen therapy but also from doctors and nurses who think ‘a bit of oxygen can’t hurt’ and might just help avoid the next admission.
It is interesting that whilst medical oxygen therapy is classed as a prescribable drug it is regarded by many health professionals and lay people as harmless and helpful.
“For those of us who visit people with oxygen in the home setting, the reality of living with home oxygen gives a very different perspective”
For those of us who visit people with oxygen in the home setting, the reality of living with home oxygen gives a very different perspective.
Whilst it is true that there is evidence for the therapeutic effects of long term oxygen therapy (LTOT) for those with severe resting hypoxaemia, many people do not realise that the survival benefit has been demonstrated only in those with COPD/emphysema and when oxygen is used for at least 15 hours a day.
The equipment available inevitably impacts on daily activities; the machines are noisy and cumbersome and the lengths of tubing supplied so that patients can walk around with oxygen create a potential trip hazard.
The evidence base for ambulatory oxygen (portable oxygen used during exertion) is even less convincing.
“You can see why so many opt to leave their oxygen cylinders at home”
The cylinders are awkward and heavy. Imagine trying to negotiate a bulky, 3.5kg cylinder every time you get up to walk around, get on the bus or go upstairs. Add to that the psychological difficulty many people experience going out with oxygen and you can see why so many opt to leave their oxygen cylinders at home.
I remember one 87 year old gentleman for whom home oxygen was not just unhelpful but potentially harmful.
He had severe emphysema but was able to potter around at home, remaining independent with the support of his equally elderly wife.
“He had severe emphysema but was able to remain independent”
Unfortunately, he required a hospital admission for bilateral pneumonia and hypercapnic respiratory failure. During his admission he was treated with controlled oxygen therapy, antibiotics, steroids and increased bronchodilators and after eight days was able to be discharged home.
He was weaker and a bit more breathless than usual but above the threshold for LTOT.
Two days after discharge, on a Friday afternoon, he contacted his local surgery complaining of increased breathlessness and reduced exercise capacity.
Over the phone, a decision was made to arrange home oxygen and within four hours an oxygen concentrator, a back up cylinder and 7 portable cylinders were delivered and he was advised to use it continuously at 4l/min.
At this point he contacted the respiratory nurses; he was extremely anxious about all the equipment and he had remembered being told that too much oxygen could be harmful for him.
He said he did not feel any worse but not ‘back to his usual’. What he really needed was reassurance and temporary additional support at home.
At his request, the oxygen was removed and at the planned reassessment six weeks later his clinical status had improved and oxygen was not required.
“We have to get away from thinking of oxygen as a treatment for breathlessness”
There is certainly a place for home oxygen therapy but, as with any medical treatment, we should consider it carefully in consultation with the patient to determine whether it is likely to be used, offer any therapeutic benefit.
Home oxygen is costly, much of it goes unused and can result in considerable anxiety and distress. We have to get away from thinking of oxygen as a treatment for breathlessness and give it as much careful assessment as any other medical therapy.
Sandra Olive, Respiratory Nurse Specialist