Friday, August 31, 2007

Friday's Newsletter - Supplemental Oxygen Use In COPD

Provided To You By COPD-Support, Inc.
Joan Costello - Editor

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The primary topic for this week's newsletter is Supplemental Oxygen.

A major topic of discussion on the Caregivers List was how Doctors prescribe the correct amount of oxygen for their patients. Some felt their doctor just
assigned a "one size fits all" number. Others voiced that the dosage was determined by either an (A) ABG, (B) a Six Minute Walk Test, (C) Spirometry, or an (D)Oximeter or a (E) combination of two or more.

A, B, C, D, and E are correct.

Over the years we've heard several opinions voiced repeatedly.

-"I only use my oxygen on occasion. I don't want to become dependent on it."

-"Too much oxygen will kill you."

-"Not enough oxygen will harm other organs."

What do the experts have to say about those statements? Read on.

Please note the distinction in the following words even though they sound pretty similar. Keep them in mind while we explore Long Term Oxygen Therapy.

-hypercapnia: A condition marked by an unusually high concentration of carbon dioxide in the blood as a result of hypoventilation.
-hypocapnia: A state in which the level of carbon dioxide in the blood is lower than normal; can result from deep or rapid breathing.
-hypoxemia: Insufficient oxygenation of the blood.

SOURCES: News items summarized in The COPD-NEWS are taken from secondary sources believed to be reliable. However, the COPD Family of Services does not verify their accuracy.

Assessment at the Level of Impairment
The oxygen transport system refers to the delivery or supply of fully oxygenated blood to peripheral tissues, the cellular uptake of oxygen, the utilization of oxygen in the tissue, and the return of partially desaturated blood to the lungs. The steps in this system include the central control of ventilation, the quality of inspired gas, and the function of the airways, lungs, pulmonary circulation, heart, blood, peripheral circulation, diffusion, gas exchange, and oxygen extraction and utilization in the muscle and tissues. Oxygen transport as a whole is uniquely sensitive to a functional change in one or more steps. No one step is rate limiting; rather each step can individually alter oxygen transport to organ tissues. The system attempts to compensate for impairment at any step. The level and degree of one or more impairments will determine the mechanism by which, and the degree to which, oxygen transport can be compensated by the unimpaired or less impaired steps in the pathway. In health, this system is acutely responsive to changes in oxygen demand, and changes oxygen delivery correspondingly. Normally, oxygen delivery or supply exceeds oxygen consumption or demand such that there is considerable reserve. To meet resting metabolic demands, oxygen consumption is normally 23% of oxygen delivery, i.e., the oxygen extraction ratio. In disease, this reserve capacity can be severely compromised.

The old adage "If a little is good, more is better" does not apply to any medication—especially oxygen. Unlike the air around you which is made up of 21 percent oxygen as well as some other gases, the supplemental oxygen your doctor prescribes is almost 100 percent medically pure. Because of this, it's considered a drug and may only be prescribed by a physician.

Not all patients with COPD require supplemental oxygen. Only your doctor can determine if oxygen will help you. He can prescribe the amount of
supplemental oxygen you need after studying the results of a blood test called an arterial blood gas and evaluating your overall pulmonary condition. He'll order a specific flow (liters per minute) of pure oxygen in the air you're breathing. This increase may be as little as one percent, but the effects on your body and your breathing may be dramatic. That's why it's important to follow your doctor's directions concerning the amount of oxygen you receive (liters per minute) and the length of time you should be using it. If not taken exactly as prescribed, it could cause problems.

The goal of therapy is to provide oxygen continuously (for at least 19 hours a day) at a level that alleviates hypoxemia (i.e., a low PaO2), thereby avoiding cellular hypoxia, a condition in which the tissue oxygen level is so low that cellular metabolism is disrupted. Hypoxemia in patients with COPD is related primarily to modest decreases in the ventilation perfusion ratio and, if present, hypercapnia; therefore, it can be corrected with low doses of supplemental oxygen. In addition to an adequate PaO2, patients need a sufficient level of hemoglobin (the primary carrier of oxygen in the blood) and an adequate cardiac output. Hypoxemia that is not corrected with low-dose oxygen therapy warrants evaluation for right-sided or left-sided heart failure, or both, which can cause decreased cardiac output.

Although long-term oxygen therapy has myriad benefits, it is expensive and intrusive. Effective therapy requires thorough patient education with frequent reinforcement, commitment by patients and often by those assisting them at home, and a competent supplier of durable medical equipment

Many patients need extensive counseling to overcome their reticence to wear a nasal cannula, especially in public.

Most patients who require extra oxygen to treat their chronic illness will need to continue their oxygen therapy.Some patients may need to use extra oxygen during a disease flare-up or infection, but may be able to reduce or stop its use if their condition improves. You should never reduce or stop oxygen therapy on your own. Talk with your health care provider if you think a change in your oxygen therapy is needed.

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The rate of cellular respiration (and hence oxygen consumption and carbon dioxide production) varies with level of activity. Vigorous exercise can increase by 20-25 times the demand of the tissues for oxygen. This is met by increasing the rate and depth of breathing.

It is a rising concentration of carbon dioxide — not a declining concentration of oxygen — that plays the major role in regulating the ventilation of the lungs. The concentration of CO2 is monitored by cells in the medulla oblongata. If the level rises, the medulla responds by increasing the activity of the motor nerves that control the intercostal muscles and diaphragm. However, the carotid body in the carotid arteries does have receptors that respond to a drop in oxygen. Their activation is important in situations (e.g., at high altitude in the unpressurized cabin of an aircraft) where oxygen supply is inadequate but there has been no increase in the production of CO2.

Local Control of Breathing
The smooth muscle in the walls of the bronchioles is very sensitive to the concentration of carbon dioxide. A rising level of CO2 causes the bronchioles to dilate. This lowers the resistance in the airways and thus increases the flow of air in and out.

Tests for Determining Oxygen Saturation
Under normal conditions, when red blood cells pass through the lungs, 95-100 percent of them are loaded, or "saturated," with oxygen. If you have lung disease or other types of medical conditions, fewer of your red blood cells will be carrying their usual load of oxygen and your oxygen "saturation" will be lower than 95 percent. Your blood oxygen level can be measured by...,2311,3644_24217,00.html

Why do I need supplemental oxygen? Normally oxygen passes readily from the lungs into the bloodstream and is pumped by the heart to all parts of the body. When lung disease occurs, oxygen may not be able to pass as readily into the bloodstream. When the heart is diseased, it may not be able to pump as much oxygen-carrying blood.

Do all patients with lung or heart disease require supplemental oxygen? It is estimated that over 4 million patients with lung or heart problems either are benefiting or could benefit from supplemental oxygen. This is a rather small percent of the estimated 60 million Americans affected by lung or heart and circulatory disease.

How can I tell if I need supplemental oxygen?
You might suspect you need supplemental oxygen if you have one or more of the following symptoms: decreased ability to exercise, difficulty breathing,
fatigue easily, periods of disorientation or loss of memory. The only way to know for sure, however, is to measure the measure the amount of oxygen in
your blood with Arterial Blood Gas or Oximetry. Your physician will evaluate your test results and symptoms to determine if you might benefit from
additional oxygen. If you need supplemental oxygen, your physician will prescribe the proper flow rate and duration of use.

How can I tell if I am getting enough oxygen?
Too much?

You might anticipate that some of the symptoms you had before using the oxygen will start to go away as your blood's oxygen level returns to normal.
The only way to be sure you are getting the right amount of oxygen is to have the oxygen level in your blood measured while using the supplemental
oxygen. If new symptoms, such as headaches, confusion, increased sleepiness, etc., appear, you might be getting too much oxygen. Notify your physician.

Do not change the liter flow or hours of usage without first checking with your physician.

Can I become addicted to oxygen?
Oxygen is not addicting. We all need oxygen to live. If your lungs and/or heart are diseased and cannot supply enough oxygen to your body from normal room air, you need to breathe supplemental oxygen. Should your condition improve, you may no longer require supplemental oxygen.

Will oxygen relieve my shortness of breath?
Oxygen frequently does help, but there are reasons other than lack of oxygen for shortness of breath. In such cases, oxygen may not relieve the
condition. By itself, shortness of breath is not life-threatening.

Functions of Blood:
1 - Transportation: oxygen and carbon dioxide nutrients waste products (metabolic wastes, excessive water, & ions)

2 - Regulation - hormones and heat (to regulate body temperature)

3 - Protection - clotting mechanism protects against blood loss and leucocytes provide immunity against many disease-causing agents
A link posted by Wes:

Position statement of the Thoracic Society of Australia and New Zealand... Because gas exchange may improve substantially on ceasing smoking, assessment should be made at least a month after the patient has stopped smoking.

...In two landmark randomized controlled trials, patients who were prescribed continuous oxygen therapy managed to use it for an average of 18 hours a day. These patients had reduced mortality compared with those using the oxygen 15 hours a day or less. Thus, the recommendation is generally that the oxygen be used for as many hours out of 24 as possible, within reason. The benefit of daytime oxygen use, which may restrict mobility, must be weighed against the benefit of exercise, which can improve quality of life.

Home oxygen may be extremely beneficial for persons with more advanced forms of COPD. Oxygen therapy is the only treatment that has been shown to extend and improve the life of COPD patients. Studies have shown that individuals who use home oxygen for most of the day and night live longer than those who do not. No other drug or therapy can make this claim.

Most insurance companies pay for home oxygen therapy based on Medicare guidelines. If a patient's arterial blood oxygen level (a blood test) is 55 mm Hg or less, or the oxygen saturation (pulse oximetry) is 88% or less in room air, that patient may qualify for home oxygen therapy.

You may be concerned about how oxygen therapy may change your lifestyle, how oxygen affects your body, and whether oxygen therapy is safe. You may worry that oxygen treatment will prevent you from leaving your home, but many convenient portable systems are available. In fact, oxygen therapy allows you to be more active by providing the oxygen that your body needs. Oxygen therapy does not cause any harm to your lungs or your body, if used as prescribed. You will not develop an addiction to oxygen. Oxygen therapy is very safe and the only thing you need to remember about safety is to keep your face and your oxygen away from flames.

MEDICAL DECISIONS. Your physician should be consulted on all medical decisions. New procedures or drugs should not be started or stopped without such consultation. While we believe that our accumulated experience has value, and a unique perspective, you must accept it for what it is...the work of COPD patients. We vigorously encourage individuals with COPD to take an active part in the management of their disease. They do this through education and by sharing information and thoughts with their primary physician and pulmonoligist. However, medical decisions are based on complex medical principles and should be left to the medical practitioner who has been trained to diagnose and advise.

Dianne/Australia: I have a short story to tell you. My GP (or PCP) was very anti me going on oxygen. He said, in his experience, people only lived for one or two years after this. I wrote to you folk about it and was immediately reassured that this was not the case! My Pulmonary Specialist who is a calm, lovely person nearly hit the ceiling when I said that I did not want to go on O2 after what my GP had told me. He said a few unprintable things.

Since I have been on O2, my whole life has changed for the better. My husband and I love to travel and we now can. I do not panic. I have the concentrator in the back of the car and at least two Oxygen tanks immediately available. I am supposed to be on 02 overnight and up to 17 hours per day.

One of the big things I have found is that I no longer get those dreadful panics - when we are traveling at a higher altitude than I am used to at home, I have the oxygen.

When I am stressed over life's little difficulties, I have the oxygen.

If the ventolin does not work immediately if I am SOB, I have the oxygen.

It is great from that viewpoint and I can now also cook again and do lots of other stuff I did not think I would do again.

O2 is a great help at a certain point in this disease - go for it and enjoy the benefits.

Please don't forget to visit the site of the online newsletter to find more links, articles, even ideas to relax and have fun!

Thanks Joan!