Supplemental Oxygen: When Do You Need to Start?

supplemental oxygen therapyCOPD is now the third leading cause of death in this country, surpassed by only heart disease and cancer.[1] What’s more, 2014 marked the 11th year in a row that more women died from the disease than men. While smoking remains a primary risk factor for COPD, air pollution, secondhand smoke, exposure to workplace dust and chemicals, heredity, a history of childhood lung infections, and socioeconomic status also play a role in its development.[2]

The Role of Oxygen Therapy in COPD

That every person with COPD will eventually need supplemental oxygen (also known as oxygen therapy) is a common misconception among COPD patients and their families. According to the American Lung Association, oxygen therapy is needed in COPD when lung function is reduced to such a degree that it interferes with normal bodily functions and the ability to maintain or increase activity.

Oxygen Therapy: Reaping the Rewards

Although some may balk at the thought of using supplemental oxygen, current research tells us that it has many benefits, including:[3]

  • Increased survival for some COPD patients when used 15 hours or more per day.[4]
  • Improved mood and sleep.
  • Increased mental alertness and stamina.
  • Prevents heart failure (in patients with severe lung disease).
  • Allows people to complete normal, everyday activities.

COPD and Oxygen Therapy Guidelines: When is it Necessary?

Oxygen is considered a drug and therefore requires a prescription from a qualified healthcare professional before being prescribed. Moreover, prior to your provider issuing a prescription, certain criteria must be met that should be based upon well-established guidelines.

Although some gray areas remain as to which patients benefit most from supplemental oxygen, the American Thoracic Society recommends long-term oxygen therapy (LTOT) for the following:[5]

  • Patients with a resting partial pressure of oxygen (PaO2) of < 55 mmHg, with an oxygen saturation level of < 88%.
  • Patients whose PaO2 is 55-59 mmHg, with a corresponding oxygen saturation level of 89%, who exhibit signs of tissue hypoxia (lack of oxygen to the body tissues), including those with pulmonary hypertension, cor pulmonale (left sided heart failure), polycythemia (increased red blood cell production), fluid retention from right heart failure, or impaired mental status.

Other Patients Who May Benefit from Oxygen Therapy

As mentioned above, there are some groups of people with COPD in which the benefits of supplemental oxygen remain unclear, but who may benefit from receiving oxygen therapy at certain times or under certain conditions. This includes COPD patients:4

  • Whose oxygen saturation levels drop when they exercise or sleep. These folks may benefit from supplemental oxygen only during these periods of time.
  • With an adequate PaO2 who have severe shortness of breath that’s relieved by low-flow oxygen therapy.
  • Who are limited in their ability to exert themselves but improve their exercise performance with supplemental oxygen.

Nocturnal vs Continuous Flow: And the Winner Is?

In 1980, the Nocturnal Oxygen Therapy Trial (NOTT) compared the efficacy of 12-hour nocturnal oxygen (used only at night) with that of 24-hour oxygen (used continuously). 203 patients with hypoxic (low oxygen) COPD were followed for at least 12 months and randomly allocated to either continuous or nocturnal-only oxygen. Study results concluded that continuous oxygen therapy was associated with a lower risk of death from COPD than was nocturnal-only oxygen.[6]

Which Type of Oxygen Therapy is Best for You?

Whether nocturnal-only or continuous flow, your health care provider will use their clinical judgment and the results of your physical exam and laboratory tests to determine if you’re a candidate for Long-Term Oxygen Therapy (LTOT).5 To find out if you qualify, talk to your health care provider as soon as possible.


[1] American Lung Association. “Taking Her Breath Away: The Rise of COPD in Women”. Executive Summary. 2013.

[2] American Lung Association. “Chronic Obstructive Pulmonary Disease (COPD) Fact Sheet”. May, 2014.

[3] American Lung Association. “Supplemental Oxygen”. 2015.

[4] Stoller, James K. et al. “Oxygen Therapy for Patients With COPD: Current Evidence and the Long-Term Oxygen Treatment Trial.” Chest 138.1 (2010): 179–187. PMC. Web. 19 May 2015.

[5] American Thoracic Society. “Appropriate Candidates for Long-Term Oxygen Therapy. Updated 2015.

[6] Nocturnal Oxygen Therapy Trial Group. “Continuous or Nocturnal Oxygen Therapy in Hypoxemic Chronic Obstructive Lung Disease: A Clinical Trial”. Ann Intern Med. 1980;93:391-398. doi:10.7326/0003-4819-93-3-391.

by Deborah Leader RN, BSN, PHN


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