Optimal Oxygen

Between equipment variability and patient activities, ensuring proper benefit from long-term oxygen therapy (LTOT) can be a challenge. Say a new patient is prescribed LTOT for 2 liter continuous flow. Which system will provide optimal results? Compressed gas, liquid oxygen, concentrators and portable combination units are among the options available, each with different performance characteristics. What works for one patient with severe chronic obstructive pulmonary disease (COPD) may not work for another.

In a recent article published in Respiratory Care,¹ Robert W. McCoy, RRT, FAARC, discussed this variability. He recommends that patients should be “tested on the equipment they will use at home at all activity levels, to ensure adequate oxygenation and benefits from the home oxygen therapy.” He also believes that physicians should be actively involved “to ensure complete assessment of a patient’s oxygen therapy needs, including patient titration, prescription and monitoring of effective patient oxygenation.”

Besides differences in equipment, activities can also affect a patient’s saturation. Activities of daily living including walking, washing and eating were associated with desaturation in patients with moderate-to-severe COPD, even without marked resting hypoxemia, in a study published in European Respiratory Journal.² And in a 2011 study published in Lung, the majority of subjects on LTOT demonstrated desaturation during walking.³

Use of a home oximeter can be beneficial in optimizing LTOT.⁴ In a May 2010 white paper for Nonin Medical titled “Pulse Oximetry at Home,” Patricia Koff, MEd, RRT, noted the benefits of using a pulse oximeter in a home monitoring program. Patients in this program checked their oxygen saturation each morning at rest and again at the completion of a six-minute walk. Benefits included early warning of deteriorating conditions, improved control of oxygen delivery both at rest and during exercise and pulse rates could be assessed and exercise goals established. Anxiety related to shortness of breath and oxygen use was reduced, and delivery of evidence-based care was improved.

Koff further noted that using an oximeter helped some patients recognize when they were desaturating and allowed them to “realize that their doctor’s advice to wear oxygen was indeed appropriate.” Personal oximeters can also provide patients with a sense of control over their disease, making them active participants in the management of their condition.

For patients who could benefit from a home oximeter, it is important to ensure they are using the correct type of device. Fingertip-style oximeters are popular options that are convenient and portable for patients to use when spot checking their saturation level and heart rate. Many clinicians recommend that patients monitoring their oxygen saturation and heart rate at home use an oximeter that has been cleared by the FDA, which requires a prescription. There are currently no over-the-counter oximeters; therefore, an oximeter that does not require a prescription is not regulated for accuracy or safety by the FDA.

Reputable oximeter manufacturers will have testing data on file to support the accuracy claims they make for their products. They will also tell you where the product is manufactured and provide information about the materials used in their product. Look for a manufacturer that provides live customer and technical support and stands behind their product with a warranty. Additionally, reputable manufacturers should be able to support clinicians and DMEs with patient education materials.