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

16 thoughts on “Supplemental Oxygen: When Do You Need to Start?”

  1. Avatar Ian Every says:

    My wife suffers from Bronchiectasis and has been hospitalised twice since Christmas for antibiotic therapy. She now suffers from severe shortness of breath and lack of energy. Would oxygen therapy be a help.

    1. Web Admin Web Admin says:

      Hi Ian, Since we are not you or your wife's primary care doctor, we cannot give you medical advice. We recommend you reach out to her primary care doctor and consult with them.

  2. Avatar June Simon says:

    My husband suffers from COPD. His oxygen level is always in the high 90s, but he always breathes heavily and gets congested with exertion. He also sleeps a lot and has no appetite. The doctors have not yet recommended oxygen. I am thinking he would feel better if he did not struggle to breath. Would oxygen help?

    1. Inogen Inogen says:

      Hi June, It sounds like your husband has stage one COPD. There are 5 stages of COPD and multiple treatment options. We recommend that your husband talks to his primary care doctor and discusses his options. For more information, please visit:

  3. Avatar chris allen says:

    Hi. my name is chris allen ive had copd for 6 years. my just told me to day he has copd. Iread on the internet. that doctors wait to long to start patients on oxygen. is it true. thank you.

    1. Inogen Inogen says:

      Hi Chris, A 2010 study funded by the Government of Ontario and the Ontario Lung Association found that COPD was under-diagnosed:
      However, with increasing awareness of COPD, we hope that public will be more knowledgeable about COPD. For more COPD facts, please visit:

  4. Avatar Jim Roberts says:

    Im at end stage COPD, my air flow stays pretty steady at 93 night and day. I can still do most of the house work, but have to take a lot of low air breaks. Would oxygen help me? Also I am thinking buying a machine instead of renting would be the way to go.

    1. Inogen Inogen says:

      Hi Jim, Are you currently on oxygen therapy? Typically patients with Stage 4 or End Stage COPD are using some sort of supplemental oxygen device. If you are currently using an oxygen therapy device like an oxygen bottle or oxygen tank or alternative portable oxygen concentrator, please give an Oxygen Specialist a call at 1-800-374-9038. If your primary care doctor has not prescribed you oxygen, please consult him or her, as you will need an oxygen prescription in order to rent or purchase one of our portable oxygen concentrators.

  5. Avatar Bill Kellerman Kellerman says:

    I don't understand, my oxygen saturation goes to low 80's without oxygen and mid 90's with, I've never had a exerbuation, I have no cough, I feel pretty much normal, Doctors say my COPD is mildly moderate, which makes me think of mild stage 2, they want me on oxygen 24/7 which has really limited my life, I even bough a Inogen for outside then I read of people at stage 3 and 4 that are not even on oxygen yet, I thought my life expectancy was 20 to 30 yrs, but now I don't know, Puzzled

    1. Inogen Inogen says:

      Hi Bill, There is a variety of reasons including age, health history, genetics, socioeconomic, and environmental factors that may explain why someone is on supplemental oxygen while someone else may not be. If your primary care doctor has recommended that you be on oxygen therapy, please follow your doctor's instructions.

  6. Avatar Gloria Love says:

    I want to know the rate of oxygen flow per min, my uncle therate of 4 lite per min. I have called ot can tell what the rate is for the Inogen.

    1. Inogen Inogen says:

      Hi Gloria, Our portable oxygen concentrators use pulse-dose technology meaning they deliver oxygen based on how the patient needs it. Your uncle is likely using a continuous flow system which you can think of like a water fountain: If an individual stands in front of a water fountain flowing at 1 liter per minute, they don’t actually drink one full liter of water. The amount of water a person drinks is a product of the number of sips and the size of the sip. The rest of the water is wasted. The same applies to continuous flow oxygen; the net amount inspired is a combination of the flowrate, the number of breaths and the size of the breaths. Pulse dose is like taking a glass of water with a straw than a fountain; the intake will be based purely on the amount and intensity of sips.

      Due to the differences between pulse dose and continuous flow technology, we encourage you to call an Oxygen Specialist at 1-800-374-9038. An Oxygen Specialist can explain to you the differences between both and can work with you and/or your uncle to determine which portable oxygen concentrator is right for his oxygen therapy needs.

  7. Avatar theodore trzaska says:

    I have stage 2 copd should I use oxygen all the time

    1. Inogen Inogen says:

      Hi Theodore, Depending on how well your lungs are functioning you may or may not need to be using supplemental oxygen 24/7. With Stage 2 COPD, lungs are functioning between 50-80% of normal lung capacity. Signs of COPD at this stage usually involve a chronic cough that may be worse in the morning, during exercise or when smoking. Please work with your primary care doctor to determine whether or not you need to be on oxygen 24/7 or part of the time. COPD is a progressive disease meaning in most cases, symptoms get worse over time. Because of this, you will need to continually work with your doctor to determine what is right for you. For more information about COPD, please visit:

  8. Avatar theodore trzaska says:

    I see a pulmonary doctor he has me on oxygen at night when I sleep but I wake up I use for a while because I cant breath even during the day I get out of breath and I use it I do little bit of yard work and I am out of breath so I have to sit down for a while I have a oxygen concentrator I use I am thinking about a oxygen for when I go somewere

  9. Avatar Deanna Pittman says:

    I have shortness of breath. I use a C-Pap machine. Can the level of pressure affect the shortness of breath!

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