Goals of Treatment
COPD is not a curable disease, but is Treatable. Instead of trying to cure COPD the focus of treatment is to:
- Slow down the damage to the lung
- Relieve symptoms, such as shortness of breath and cough
- Build up overall body fitness
- Decrease flare-ups
- Improving quality of life
Stop Smoking
The most important step in treating COPD is to STOP SMOKING (see Stop Smoking). Smoking causes a progressive loss of lung function.
When you quit, you stop the damage to the lung and your lung function may improve with time. Everyone can benefit from not smoking, no matter how old you are.
(See Smoking Cessation)
Long Term Home Oxygen Therapy (LTOT)
More and more people are using oxygen therapy outside the hospital, giving them the freedom to lead active, productive lives. People with asthma, emphysema, chronic bronchitis, occupational lung disease, lung cancer, cystic fibrosis, or congestive heart failure may use oxygen therapy at home.
Benefits of LTOT
- Increase survival rate, if oxygen is worn for at least 15 hours per day
- Decrease shortness of breath
- Improve quality of life
- Decrease feeling of being tired
- Improve sleep
- Decrease work of the heart
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What the Prescription Tells You
- How many hours a day do I use the Oxygen? ______
- What flow rate do I use with:
Normal Activity: ______
Exercise: _______
Sleep: _________
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Prescription for Oxygen
Oxygen is a drug and a physician must write a prescription for oxygen therapy. The prescription will spell out the flow rate, how much oxygen you need per minute - referred to as liters per minute (LPM or L/M) - and when you need to use oxygen. Some people use oxygen therapy only while exercising, others only while sleeping, and still others need oxygen continuously.
Tests to Determine the Need for Oxygen
Your physician will order a test that will indicate what your oxygen level is and help to determine what your oxygen needs are. One or both of these testing methods may be used.
Oximetry
Your oxygen level may be measured as a percentage of oxygen in your blood. This is called oxygen saturation.
Oximetry is one way to measure oxygen saturation in your blood. A small clip is placed on the finger, toe, earlobe, or an infant’s foot. This is a simple, painless way to determine your need for oxygen.
This test may be done at rest, during sleep or while you are exercising.
Arterial Blood Gas
The arterial blood gas is where blood is taken from an artery (generally taken from the wrist or elbow area). The results can provide more information about how your lungs are working and how your body is responding to decreased levels of oxygen.
How to Locate an Oxygen Supplier
Medicare has resource tool that will help you to find medical equipment companies who supply oxygen (as well as other home medical equipment). You enter in your zip code and needed equipment and a list of companies is produced. Additionally, information about Medicare reimbursement is produced.
The web site address is: www.medicare.gov/Supplier/Home.asp
Insurance
Certain insurance policies may pay for all your oxygen, but payment is based on laboratory results, diagnosis, and other information. Your physician or medical equipment and services provider may be able to answer your questions about coverage.
Oxygen Delivery Devices
There are three common means of oxygen delivery.
- A nasal cannula is a two-pronged device inserted in the nostrils and it is connected to tubing carrying the oxygen from the oxygen equipment.
- Transtracheal oxygen therapy requires the insertion of a small flexible catheter in the trachea or windpipe. The transtracheal catheter is held in place by a necklace. Since transtracheal oxygen bypasses the mouth, nose, and throat, a humdifier is absolutely required at flow rates of 1 LPM or greater.
- People who need a high flow of oxygen generally use a mask.
- Tracheotomy is a surgical procedure in which an opening is made in the trachea and a tube is inserted. Oxygen can be delivered to the tracheotomy tube by masks or adapters that are directly connected to the tracheotomy tube.
Oxygen Systems
There are three common ways of providing oxygen therapy. Oxygen can be delivered to your home in the form of a gas in various-sized cylinders or as a liquid in a reservoir (container) The third way to provide oxygen therapy is by using an oxygen concentrator. Each method is examined in more detail below.
Compressed Gas – Oxygen is stored under pressure in a cylinder equipped with a regulator that controls the flow rate.
Oxygen can be provided in a small cylinder that can be carried with you. The larger tanks are heavy and are only suitable for stationary use.
Because the flow of oxygen out of the cylinder is constant, an oxygen-conserving device may be attached to the system to avoid waste. This device releases the gas only when you inhale and cuts it off when you exhale.
Liquid Oxygen
Oxygen is stored as a very cold liquid in a container very similar to a thermos. When released, the liquid converts to a gas and you breathe it in just like the compressed gas.
This storage method takes up less space than the compressed gas cylinder, and you can transfer the liquid to a small, portable reservoir at home. Liquid oxygen is more expensive than the compressed gas, and the reservoir vents when not in use (see safety issues).
An oxygen-conserving device may be built into the reservoir to conserve the oxygen.
Oxygen Concentrator
This is an electrically powered device that separates the oxygen out of the air, concentrates it, and stores it. This system has a number of advantages because it doesn't have to be refilled and it is not as costly as liquid oxygen.
Extra tubing permits the user to move around with minimal difficulty. Small, portable systems have been developed that afford even greater mobility.
You must have a cylinder of oxygen as a backup in the event of a power failure. You should advise your electric power company in order to get priority service when there is a power failure.
Home oxygen is safe.
Oxygen is not addictive.
Safety Issues
Fire
- Oxygen will not “blow-up” but it will support combustion; it is a fuel for the flame/fire.
- DO NOT SMOKE while wearing your oxygen. Nasal cannulas and masks can catch fire and cause serious burns to face and airways.
- Do not use flammable liquids such as: paint thinners, cleaning fluids, gasoline, kerosene, oil-based paints, aerosol sprays, etc while using oxygen.
- Keep fire extinguisher in working order and in areas where you use your oxygen (dry or CO2 extinguishers).
- Install smoke alarms on every level of your house. Alarms should be checked monthly and change batteries at least once a year.
Storage
- Do not store oxygen cylinders and liquid systems in closets, behind curtains, covered with clothing or in unventilated areas. These oxygen systems ‘vent’ or ‘let off’ a small amount of oxygen and this vented gas can accumulate in confined space and become a fire hazard.
- Secure oxygen cylinders in racks or appropriate stands.
- Turn cylinder valves to the ‘off’ position when not in use.
- Do not use bedding or clothes made of wool, nylon, or synthetic fabrics, as these materials have the tendency to produce static electricity. The use of cotton material bedding and clothes will avoid sparks from static electricity.
- Do not store oxygen cylinders in the trunk of your car.
Inform
- Inform your electrical company if you are using a concentrator and/or ventilator so in case of a power failure they will know the medical urgency of restoring your power.
- Post a “No Smoking” sign outside of your home.
- Inform your local fire department that you have oxygen in the home.
Everyday Safety
- Keep at least eight feet away from open flames, i.e. candles, barbeque grills, cigarettes, cigars, gas stoves, fireplaces,
- Avoid using heat sources such as space heaters, electric blankets, hair dryers, etc. while using oxygen.
- Use properly grounded electrical outlets for oxygen concentrators.
- Do not run oxygen tubing or electrical cords under carpets or furniture.
- Do not use oil or petroleum-based products. Vaseline products should not be used for dryness. Instead try water-based products such as K-Y jelly.
- When in a restaurant, choose to sit in no smoking areas and remove candles and warming burners from table.
- Check equipment for proper functioning.
- Keep oxygen supplier phone number handy, in case you need their help.
- Liquid oxygen is extremely cold (-297 degrees Fahrenheit). Touching liquid oxygen or parts of oxygen system can quickly freeze skin. Also the vapors form the liquid oxygen are cold and could cause damage to the skin or lungs.
Care of Equipment
The home medical equipment and services company that provides the oxygen therapy equipment you use should provide you with instructions on user care and maintenance of your equipment.
General Guidelines for Cleaning
- You should wash your nasal cannula (prongs) with a liquid soap and thoroughly rinse them once or twice a week.
- Replace cannulas every two to four weeks.
- If you have a cold, change cannula when your cold symptoms have passed.
- If you use an oxygen concentrator, unplug the unit, then wipe down the cabinet with a damp cloth and dry it daily.
- The air filter should be cleaned at least weekly.
- Your home medical equipment and services company should inspect the unit on a periodic basis; call the company if you suspect any problems with your equipment.
Helpful Tips
- Don't ever change the flow of oxygen unless directed by your physician.
- Problems with your nasal cannula? Ask your oxygen supplier about these products:
- There are hypoallergenic nasal cannulas available for your sensitive nose.
- Don’t like the looks of the nasal cannula? There is a product that has the nasal cannula tubing built into an eyeglass frame.
- Ear pads and tubing covers can reduce irritation around the ears.
- Special gels are available to moisturize the nose and skin around the nose.
- Be sure to order more oxygen at least two to three days before you need it.
- Use backpacks or rolling carts to carry portable oxygen systems.
When to Call Your Doctor
- If it is an emergency call 911
- If you are having any signs or symptoms of a respiratory flare-up:
- Increased shortness of breath
- Not feeling well, your usual daily activities may be more tiring and require more physical effort.
- Increased amount of mucus. It may also be thicker and greenish in color.
- Increased need for lung medication
- Recent viral or bacterial infection
- Wheezing
- Exposure to high pollution levels
- Exposure to irritants; chemicals, smoke, dust, etc.
- Fever
- For further information see Flare-ups
- If you, or others, see changes in your “normal” breathing: slow, shallow, rapid, difficult, and/or irregular breathing.
- Unusual and/or frequent headaches
- You, or others, see a blue tint to your lips or fingernails
- Increased drowsiness
- Onset of confusion
- Increased level of restlessness
- Unexplained anxiousness and/or anxiety
