Pros and Cons of Types of Oxygen Therapy

Oxygen Systems Vary in Convenience, Price, Ease of Use

© Barbara Bell

Jan 7, 2009

If all statistics on the prevalence of lung disease were combined, it would rank as the #3 killer in America. Among the diseases which kill one out of seven Americans are lung cancer, COPD (chronic obstructive pulmonary disease), asthma, sarcoidosis, pulmonary hypertension, influenza, and pulmonary fibrosis. (Women's Health.gov)

Several of these diseases in their later stages are treated with oxygen therapy. At the point where an individual can no longer maintain a blood saturation level of 90% or greater, the physician will prescribe oxygen. The normal level is 95-97%; below 90% is called hypoxemia. Some insurance companies will cover oxygen therapy if the SP02 (Saturation of Peripheral Oxygen) is as low as 88%, others at 90%. One's physician will make the decision, as a prescription is required to receive oxygen therapy.

A detailed oxygen prescription indicates:

1. the oxygen dose (liters per minute, or lpm),
2. the number of hours per day that oxygen therapy is required,
3. the dose required during exercise,
4. the oxygen supply system: concentrator, compressed gas cylinder, or liquid oxygen reservoir, and
5. the delivery device: nasal cannula, demand-flow device, reservoir cannula, or transtracheal oxygen catheter.

Types of Oxygen Available to Patients

The three commonly used forms of oxygen available for home-care are:

• Oxygen in the form of gas in various sizes of cylinders
• Liquid oxygen in storage tanks or portable cylinders
• Oxygen extracted from ambient air by a concentrator

Oxygen in the Form of Gas in Cylinders

Stored under pressure, and released at a set flow rate by a control device, this is the most common oxygen source available to patients. One can use portable cylinders outside the home.

Pros:

1. Constant 100% oxygen available to patient
2. Doesn't expel any heat into the environment
3. Portable (in smaller vessels)
4. Doesn't require electricity
5. Oxygen temperature at delivery is 65-72 degrees F

Cons:

1. Can be expensive to rent, but if tanks are purchased may be cheapest source
2. Needs a lot of storage space
3. Supply is limited to the number of tanks on hand
4. Heavy and awkward to use

Liquid Oxygen

Stored as a liquid in a sealed container, the oxygen vaporizes when released and can be breathed. This form of oxygen must be provided by a service company and the tanks are owned by the company. Monthly rental includes replenishing the main tanks as often as required.

Pros:

1. Easy to use
2. Quieter than concentrator
3. Constant level of 100% oxygen
4. Does not expel heat into environment
5. Does not use electricity
6. Little or no maintenance
7. Oxygen temperature range of 55-72 degrees F
8. Portables are the most convenient in size, duration and weight

Cons:

1. More expensive as tanks must be rented as long as needed
2. Storage of main tanks may be a problem
3. Can freeze up on high flow
4. Not always available from all suppliers

Oxygen Concentrators

An electrically powered machine that takes ambient air, splits it, concentrates and stores it. When it is needed, it is immediately available without needing to be replenished. Small portable versions are available. A back-up system must be available in case of power failure, and arrangements must be made with utility company to restore power as soon as possible.

Pros:

1. Can be purchased or rented
2. Easy to operate
3. Some portables are approved for use on airlines

Cons:

1. Oxygen concentration is lower than other two sources – 87%-95%
2. Requires weekly maintenance
3. Expels heat into the environment
4. Requires electricity
5. Can be very noisy
6. Oxygen temperature rate of 70-78 degrees F

Delivery Mechanisms

Most patients use a nasal cannula although some who require a very high flow will use a face mask. Low flow is from 1 to 6 liters per minute; high flow is 6 to 15 liters per minute. Requirements above that level may involve combining more than one tank, with a Y-valve connecting the tubing. Use of an Oxymizer™ (oxygen saving device) will increase the available oxygen by capturing the exhaled oxygen and combining it with the next inhalation to effectively double the liter rate per minute. (Ohio Hospice and Palliative Care/Hospice)

Impact of Lung Disease in America

Data from the mid-1990's estimates that between 600,000 and 800,000 patients received long-term oxygen therapy in the United States at a yearly cost estimated between 1.4 and 1.8 billion dollars. Other data suggests that the Veterans Health Administration is responsible for up to 15% or approximately 100,000 home oxygen patients at a given time. (National Ethics Teleconference; keynote speech "Home Oxygen for Patients Who Smoke: Prescription vs. Proscription", October 23, 2001)

Obviously lung disease has a tremendous effect on the lives of millions of Americans and their families, their employers and their communities. The use of oxygen therapy will continue to grow and present significant increased expense to the individuals, as well as the healthcare system in the US.

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