What is oxygen therapy?

Different types of oxygen therapy

There are two types of oxygen therapy:

• Hyperbaric oxygen therapy: This is used only in special emergency situations such as decompression sickness or carbon monoxide poisoning, for example. Oxygen is administered at a higher than normal pressure in a specific chamber called a "hyperbaric chamber". 
• Normobaric oxygen therapy: This type of oxygen therapy involves breathing oxygen through a medical device to improve the patient's ventilatory capacity. We will only discuss this type of oxygen therapy throughout the rest of this article.

Pulmonary gas exchange: How does it work?

Source: Gas Exchange, Byjus

Gas exchange occurs from the place where the pressure is higher to the place where the pressure is lower. This is why oxygen (O₂) will pass from the pulmonary alveolus to the blood and bind to hemoglobin. The O₂ can then be distributed to the body's organs and allow them to function. When the blood returns to the lungs, it is highly charged with carbon dioxide (CO₂), which will pass through the alveoli to be exhaled from the body.

When gas exchange is disturbed, two phenomena occur:

• Hypoxemia: This refers to a lack of oxygen in the blood. It is defined when the oxygen pressure in the blood is <70 mmHg (millimeters of mercury).
• Hypercapnia: This is an excess of carbon dioxide in the blood. It is defined when the pressure of CO₂ in the blood is >45 mmHg.

Both of these phenomena can have repercussions on all the organs of the human body. Poor blood oxygenation prevents the organs from functioning normally and may lead to multiple disorders. The direct consequences may include: difficulty breathing (dyspnea), morning headaches, and chronic fatigue.

Oxygen therapy can be put in place to prevent hypoxemia and hypercapnia in the long term.

When is oxygen therapy prescribed?

Arterial blood gases testing (ABG) can be used to determine if a patient has respiratory failure, the condition in which the lungs cannot take in sufficient oxygen or expel sufficient carbon dioxide to meet the needs of the cells of the body. Respiratory failure can be acute, chronic or intermittent (e.g. sleep apnea). Several health conditions may require oxygen therapy, the most common of which is chronic obstructive pulmonary disease (COPD).

COPD is a chronic inflammatory disease that affects the airways and more particularly the bronchi. The consequences of this condition are breathing difficulties with obstruction and narrowing of the airways. A destruction of the lung parenchyma called emphysema is often associated with COPD. COPD is only managed with oxygen in the most severe stages. 

Other conditions are also treated with oxygen therapy, such as cystic fibrosis and interstitial lung disease. More recently, some patients with COVID-19 have been able to use oxygen therapy. 

What are the different types of oxygen therapy equipment?

Oxygen can be administered in different forms. After evaluating the patient's needs, a doctor may prescribe one of the following forms:

• A stationary device: These include concentrators, liquid oxygen, or compressed oxygen cylinders.
• A portable device (to facilitate use outside the home): Including, portable concentrators, portable liquid oxygen, or oxygen gas tanks.

The patient should also be equipped with a breathing system such as a nasal cannula (a device with two mouthpieces that allows oxygen to be delivered directly to the nostrils) or a face mask. 

In the case of COPD care, oxygen concentrators are the most commonly used method of home oxygen therapy.

Oxygen therapy in practice

Oxygen therapy must be adapted according to the patient's lifestyle. There are 3 flows rates according to different situations: flow rate at rest, flow rate during exercise and flow rate during sleep. 

In addition, to obtain an optimal effect, training remains a key element:

• Understanding treatment methods: Frate, duration of daily use, using and maintaining the equipment,
• Re-evaluation the prescription with a healthcare professional: In the case of stabilised conditions such as COPD, oxygen therapy should be prescribed for life.   

Quitting smoking is a must when starting oxygen therapy. Smoking could negate the effects of oxygen as well as lead to fire or burn hazards from the oxygen as well.

Oxygen therapy can impose a number of restraints on daily life, so it is important to discuss this choice at length with a specialized health professional.

Pulmonary rehabilitation

Pulmonary rehabilitation is a set of techniques and treatments to improve respiratory capacity. It is personalized according to the patient's needs and is carried out by several health professionals. This program can be carried out in a hospital, in a local facility (physical therapy center or doctor's office) or at the patient's home.

Respiratory rehabilitation can be implemented when patients experience a decrease in their quality of life with, for example, dyspnea, a decrease in daily activities or exercise intolerance, despite appropriate treatment. It can be performed in parallel with oxygen therapy.

First, it will be necessary to evaluate the patient's capacity at rest (spirometry) and during exercise (exercise ECG). A clinical evaluation (evaluate dyspnea, quality of life, psychosocial, etc.) should be conducted, as well as an evaluation of any comorbidities. In order to provide the best possible care for the patient, the patient and doctor should try to identify the nearest respiratory rehabilitation center and to ensure good coordination between all the health professionals involved.

The course consists of a minimum of 12 sessions. There are, on average, 20 sessions over a period of 6 to 12 weeks. In order to achieve a better recovery in the long term, it is important to continue the efforts for a period of 6 months to 1 year with regular and personalized exercise and a therapeutic education program. In addition, and if necessary, dietary or psycho-social support, as well as respiratory physiotherapy can be recommended.

Breathing techniques for stress relief

Everyday life can sometimes be difficult to cope with, with situations that can disrupt therapy. Stress is often the cause of breathlessness and can make it worse. It is important to manage stress in everyday life to avoid attacks of breathlessness. Daily physical activity adapted to your needs and abilities can help you to manage your stress and breath better. Breathing exercises can be a great way to marry the two.

Here are some breathing techniques for when you feel breathless. When you are in one of the following positions, breathe gently to try to calm your breathing. To find out which exercises are best for you, talk to your doctor or another healthcare professiona

Source: Les positions du corps pour réduire l’essoufflement - BPCO.org

While sitting, place both feet on the ground, with your elbows on your the knees and head resting on your hands (left image) OR both feet on the ground, with your elbows and head resting on a flat surface (right image).

Source: Les positions du corps pour réduire l’essoufflement - BPCO.org

While standing, bend over slightly with your hands placed on your thighs (left image) OR bend over slightly with your elbows resting on a flat surface (middle image) OR bend over slightly with your hands supporting yourself on a flat surface (right image)

Conclusion

Oxygen therapy is often viewed as a burdensome or demanding treatment for patients, but it doesn't have to be! With proper education and regular support from healthcare professionals, patients on oxygen therapy can live normal, fulfilling lives!

Would you like to read a Carenity member's experience with oxygen therapy? Read about Maria's journey with oxygen therapy, an O₂ tank, and pulmonary rehab below:

COPD: Oxygen therapy, O2 tanks, and rehabilitation

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