The good news: Oxygen systems are becoming smaller, lighter and more portable--which means your need to use supplemental oxygen won't compromise mobility and independence.

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People with severe chronic obstructive pulmonary disease (COPD) may have very low levels of oxygen in their blood. This is called hypoxemia, and it may cause increased difficulty breathing and further impair your ability to exercise, requiring COPD oxygen therapy.

Low COPD oxygen levels may also cause fatigue, memory loss, headaches in the morning, depression, and confusion. Over time, chronically low oxygen levels also can cause heart failure and impact COPD life expectancy. This makes COPD oxygen therapy a major treatment approach for stage 4 COPD.

Do You Need COPD Oxygen Therapy?

To determine whether a person with COPD has hypoxemia, a physician will perform either an arterial blood gas test or pulse oximetry, both of which measure the amount of oxygen in the blood.

With oxygen therapy, COPD hypoxemia levels may not be as poor, but oxygen therapy usually is given only to patients with very severe (stage 4) COPD. In Stage 4 COPD, airflow is severely limited and the amount of air that can be blown out in one second (called the FEV1 ratio) is less than 30 percent of what would be expected for someone without lung disease. For these people, long-term use of supplemental oxygen for more than 15 hours each day can extend COPD life expectancy and improve the quality of life.

COPD oxygen therapy also may reduce shortness of breath during exertion, which makes it easier to perform activities of daily living. Oxygen therapy also may improve mental functioning, reduce depression, and aid the heart.

Using COPD Oxygen Therapy for Hypoxemia

Supplemental oxygen may be used continuously (24 hours) or periodically, such as only during exercise or overnight. The primary goal of using supplemental oxygen is to ensure adequate delivery of oxygen to preserve the function of vital organs.

Normal atmospheric air is about 21 percent oxygen, but the amount of oxygen you breathe into your lungs can be increased with additional pure oxygen that you inhale with each breath. Your doctor will prescribe a specific amount of supplemental oxygen, and provide instructions on when and how long it should be used, as well as which delivery method will be used. There are three methods for delivering oxygen—with each system, the oxygen is breathed in through a mask or a nasal tube (cannula).

• Compressed oxygen gas: Compressed oxygen gas is contained in tanks or cylinders of varying sizes. Large stationary tanks are used inside the home, while smaller, more portable tanks can be used on brief forays outside the home (they usually have enough oxygen to last a few hours).
• Liquid oxygen: When oxygen gas is cooled, it produces a liquid form of oxygen. When the liquid is warmed, it turns back into a gas that can be inhaled. Like compressed oxygen gas, liquid oxygen systems include a large tank for use in the home. The system also includes a small portable canister for use outside the home (this canister is filled with liquid oxygen from the indoor tank). One disadvantage of liquid oxygen systems is the tendency for the liquid to evaporate over time.
• Oxygen concentrator: An oxygen concentrator is an electric device that takes air from the room and separates the oxygen from other gases. The oxygen is then available to be inhaled through a mask or nasal cannula. This system does not require that tanks of liquid or gaseous oxygen be continuously refilled. The supply of oxygen is unlimited and the device is small enough to be moved from room to room—however, it is not portable enough to be taken outside, and it requires electricity to operate.

Traveling with COPD Oxygen Therapy

If you need to travel by air and you use COPD oxygen therapy, you will need to notify the airline well in advance in order to arrange for use of oxygen during the flight. Also keep in mind that even if you don’t require COPD oxygen therapy at home, you may need supplemental oxygen while flying. This is because the air pressure inside an airplane cabin is lower than it is on the ground, especially when the airplane is taking off and landing.

Low air pressure decreases the amount of oxygen in the air. People without lung disease can adapt to the changes in air pressure, but for a person with severe COPD, even a small change in air pressure may cause an exacerbation of symptoms.

Always discuss air travel plans with your doctor. Lung function tests will likely be needed to determine whether supplemental oxygen is required, and your doctor will also need to provide a letter for the airline. During the flight, the oxygen will be provided by the airline (there will likely be a fee for this service), since passengers are not allowed to bring their own oxygen canisters on board an airplane.

Information about which airlines permit the use of oxygen on flights, along with their policies, is available from the Airline Oxygen Council of America (www.airlineoxygencouncil.org).

For further reading on COPD, see these University Health News posts:

• “Is There a COPD Cure? Here’s the Answer“
• “GOLD COPD Guidelines for Lung Disease Treatment“
• “Is There Such a Thing as a COPD Diet?“
• “How to Prevent Smoking Diseases—and Add Years to Your Life“

Originally published in May 2016 and updated.