Oxygen Therapy

Resources for Oxygen Therapy

Oxygen Support Line

844-825-5733

If your health care professional has prescribed oxygen therapy, we have resources to help you learn more about this important treatment.

Oxygen is prescribed when oxygen levels go below about 88%. Your doctor may choose to measure your oxygen level in different circumstances: while sitting, while walking in the hallway or on a treadmill, and during sleep. If your oxygen level drops below about 88%, your doctor may prescribe supplemental oxygen to prevent your oxygen level from dropping further. Many people report that they have less breathlessness and fatigue, and are better able to live an active lifestyle when using oxygen.

Using oxygen can be frustrating and inconvenient. We recommend that you talk openly with your doctors about your concerns. Some people find it difficult to adjust to using oxygen, particularly when outside the home. But over time, most people find that the benefits of using oxygen greatly improve their quality of life. 

When you use oxygen, you are doing something important for your health. In addition to reducing breathlessness and fatigue, supplemental oxygen can reduce stress on your organs. People living with PF can jog, work out, and play sports (with permission from their doctors) while using oxygen.  

Questions Regarding Oxygen Therapy?

Call the PFF Oxygen Information Line at 844-825-5733! Below are some of the most commonly asked questions, however we are here to answer any and all questions or concerns. 

  • Oxygen safety
  • Types of oxygen systems
  • Traveling with oxygen
  • And more!

PFF Oxygen Resources

Oxygen Basics

Why is oxygen needed?

Every cell in your body needs oxygen to work. Oxygen moves from your lungs into your blood, which carries it to the rest of your body. Oxygen levels are measured using a device called a pulse oximeter, or by taking a blood sample.

What are the potential benefits of using supplemental oxygen?

  • Reducing breathlessness
  • Increasing your ability to maintain an active lifestyle
  • Helping to reduce stress on other organs
  • Although there are not currently any studies showing that supplemental oxygen prolongs life in pulmonary fibrosis patients, there are studies showing that supplemental oxygen prolongs life in patients living with chronic obstructive pulmonary disease (COPD).

Will I experience symptoms if I need supplemental oxygen?

You might. Many people experience shortness of breath or fatigue. Other possible signs that you are not getting enough oxygen include irritability, morning headaches, blue fingertips or lips, and ankle swelling.

However, some people may not experience symptoms even when they are not getting enough oxygen into their bloodstream

IS SUPPLEMENTAL OXYGEN ADDICTIVE?

No, it is not. Use oxygen as prescribed by your healthcare provider.

How will my healthcare provider determine if I need supplemental oxygen?

Your healthcare provider (HCP) may test your need for supplemental oxygen by measuring the oxygen level in your bloodstream at rest, while walking or exercising, and/or during sleep. For example, you might have heard of the 6-minute walk test. This is one type of test commonly used to determine whether you need supplemental oxygen while walking. Your healthcare provider will decide which test(s) are right for you. You will need a face-to-face visit with your healthcare provider and testing for insurance purposes.

If your HCP finds that your oxygen levels are low during testing, they will determine whether you need supplemental oxygen, when you need oxygen (whether at rest, during activity, and/or during sleep), and how much oxygen you need in each setting.

WHAT DOES AN OXYGEN PRESCRIPTION INCLUDE?

  • When to use your oxygen (during sleep, rest, activity, or at altitude)
  • How much oxygen you need for each activity (number setting if you use pulse dose flow or liter flow if you use continuous flow)
  • What type of oxygen equipment fits your lifestyle and oxygen requirements
  • A “Certificate of Medical Necessity” (required by Medicare and many other insurances)

Only your healthcare provider can change your oxygen prescription.

What role will my healthcare provider play in managing my supplemental oxygen?

  • Identify your supplemental oxygen needs
  • Order the appropriate testing
  • Provide the prescription for supplemental oxygen and any other documentation to support the need for supplemental oxygen (including the “Certificate of Medical Necessity,” often needed for insurance)
  • Work with the home oxygen company supplying supplemental oxygen
  • Assist you with determining your oxygen needs for travel

Additionally, a recent study found that patients who received education from healthcare providers about supplemental oxygen were less likely to have problems with their supplemental oxygen than those who did not receive education or were only educated by the person delivering their supplemental oxygen (Jacobs et al., Patient Perceptions of the adequacy of Supplemental Oxygen Therapy). We encourage healthcare providers and patients to work together to ensure that the patient is fully educated about the proper and safe use of their supplemental oxygen equipment.

What role does the home oxygen company play in supplying my supplemental oxygen?

  • Provide a basic oxygen system, including any equipment and disposable supplies (such as nasal cannulas or humidifiers)
  • Provide 24-hour emergency service for equipment malfunctions or power outages
  • Provide education on the proper and safe use of equipment
  • Verify insurance coverage and bill insurance

What ARE SOME OXYGEN SAFETY BASICS?

  • Avoid flames, sparks, cigarettes, matches, lighters, gas stoves, pilot lights, hair dryers (use the cool setting only), and frayed electric cords.
  • Oxygen is not flammable and does not explode on its own, but it will make a fire burn faster.
  • Compressed tanks should be kept 8-10 feet from open flames or sparks.
  • Avoid petroleum-based products to moisturize your face or nose.
  • All oxygen tanks should be secured to avoid falling and becoming projectiles.
  • Do not store tanks in closets, in direct sunlight, or next to heat sources.
  • Do not use cracked or broken tanks.
  • Stationary concentrators should be well-ventilated. Do not store items on top of stationary concentrators.
  • Contact your electrical company and fire department to let them know that you use supplemental oxygen. It is important that they are aware of your need for supplemental oxygen in case of a power outage.
  • Keep smoke detectors and fire extinguishers in your home.

How do I know that I’m using the right amount of oxygen?

Your HCP may ask you to monitor your oxygen levels periodically using a pulse oximeter.

Ask your HCP what your target oxygen level should be. If your HCP asks you to, you can adjust the flow of oxygen depending on what you’re doing to keep your oxygen level in a recommended range recommended by your HCP.

What should I do to maintain my oxygen equipment?

  • Ask your home oxygen supplier for instructions for cleaning and maintaining your specific equipment. 
  • Here are some basics that you might need to consider:
    • Change the nasal cannula and the long tubing for the stationary system regularly.
    • Most oxygen concentrators require a regular filter cleaning.
    • If you are using a humidifier, it should be washed regularly. Only fill it with distilled water, NOT tap water.
    • Face masks should be cleaned regularly.
    • Ask your home oxygen supplier to schedule a yearly servicing for your concentrator.

What type of oxygen system is right for me?

You should work with your healthcare provider and your home oxygen supplier to identify the oxygen system that will be the best fit for your lifestyle and oxygen requirements. Some of the things you will consider include how active you are, how often you leave home and how long you are gone for, your physical strength, and your personal preferences.

What are the types of oxygen systems?

Most patients will receive an in-home, stationary unit as well as a portable system that will allow you to leave the home.

  • Primary types of stationary systems
    • Stationary Concentrator
      • A stationary concentrator pulls oxygen from the air in the room to create a stream of concentrated oxygen through the oxygen tubing.
      • A stationary concentrator usually stays in the room where it is placed. You can use different lengths of oxygen tubing to move around your home or workplace.
      • The cost of electricity for running the concentrator is not covered by insurance. The expense of electricity may be tax deductible, but this depends on a number of factors. You should check with a tax professional about your specific situation.

       

    • Stationary liquid systems
      • When oxygen is cooled to a very low temperature, it becomes liquid.Theliquidoxygen is stored in a container. As the liquid oxygen leaves the
        container, it warms up to room temperature and becomes a gas, which then flows into oxygen tubing.
      • Stationary liquid systems are quiet, do not have any major moving parts, and do not require a power source to operate.
      • Not every home oxygen supplier offers liquid oxygen.

       

    • Primary types of portable systems
      • Compressed gas tanks
      • These are green and silver (aluminum) tanks filled with compressed oxygen gas.
      • Tanks come in a variety of sizes.
      • During use, smaller tanks run out of oxygen more quickly than larger tanks.
      • Some compressed gas tanks can be filled at home with a concentrator filling system, often referred to as a transfill unit.
      • You might choose to use a backpack or a rolling option for carrying compressedgas tanks. There are different options available; work with your home oxygen company and your healthcare provider to find a good fit for your needs.

       

    • Liquid portable tanks
      • Liquid portable tanks are used along with a stationary liquid system.
      • It requires training to learn how to fill a liquidportable tank from the stationary liquid system. There is a risk of cold burning if it is not done properly. You should work with your home oxygen supplier to make sure you understand the system.
      • Liquid oxygen units should be kept upright to prevent leaks.
      • Weighing 3-11 pounds, these units provide higher continuous flows than portable oxygen concentrators.
      • Not every oxygen company offers liquid oxygen.

       

    • Portable oxygen concentrators
      • A portable oxygen concentrator (POC) is a
         smaller version of a stationary concentrator.
      • The POC runs on batteries. In many circumstances you may need to carry extra batteries to keep the unit running. The battery life depends on factors such as liter flow and POC size.
      • Generally, the smaller the unit, the lower the oxygen output (liter flow or pulse settings) and the shorter the battery life.
      • POCs can be recharged via wall plug or car battery.
      • The POC is the accepted type of oxygen system that can be used on airplanes, although you must contact your airline ahead of time to ensure you can bring your POC on the plane.
      • Many people who require high flow oxygen need more oxygen flow than a POC can provide. If you are considering a POC, please talk with your HCP first to make sure that this type of device will meet your needs.

What is pulse or demand flow? Is it the same thing as
continuous flow?

With pulse flow (also known as demand flow), your portable oxygen system senses when you inhale and ONLY delivers a pulse of oxygen when you breathe in, allowing tanks and batteries to last longer. Pulse dose flow is not the same thing as continuous flow. Continuous flow provides a continuous flow of oxygen into your nose, even when you are not breathing in.

Pulse flow and continuous flow are both prescribed as numbers but the numbers do NOT mean the same thing. A continuous flow setting of 2, 3, or 4 liters per minute is not the same thing as (and is usually more than) a pulse flow setting of 2, 3 or 4.

Pulse flow is not appropriate for all patients. Talk with your healthcare provider about the right options for you.

What should I know about nasal cannulas and tubing?

  • All stationary systems connect to tubing (25 or 50 foot) for use.
    Oxygen set above 6 litersper minute uses special “high-flow” tubing, and may require a face mask instead of a cannula.
  • The part that goes in your nose is called cannula or nasal cannula.
  • If you use high flow oxygen, your healthcare provider may recommend a reservoir nasal cannula. This type of cannula, also known as an Oxymizer®, helps to maximize the delivery of oxygen. Reservoir nasal cannulas cannot get wet and should not be worn in the shower.

Do I need a humidifier with my supplemental oxygen?

If you use high flow oxygen, ask your healthcare provider about whether you might needa humidifier with your oxygen. Using a humidifier with high flow supplemental oxygen can help prevent nasal membranes from drying out.




What is transtracheal oxygen therapy?

Transtracheal oxygen therapy is an alternative to a nasal cannula or a face mask.

This is NOT a tracheotomy. A plastic catheter is surgically placed in the patient’s neck and sits in the windpipe. Oxygen is delivered directly into the windpipe through the catheter.

How does Medicare pay for supplemental oxygen?

If you qualify for supplemental oxygen and receive Medicare, Medicare creates a five-year contract with your home oxygen supplier. The contract starts the first month that your home oxygen supplier bills Medicare. During the first 36 months of the contract, your home oxygen supplier is paid for the rental of the equipment. During the last 24 months of the contract, your home oxygen supplier is only paid for providing you with items such as tubing, refilled tanks, and other supplies. Your home oxygen supplier still must service and maintain your supplemental oxygen equipment during the last 24 months of the contract.

Medicare pays for 80% of fees associated with supplemental oxygen while you as the patient are responsible for the other 20%. Some supplemental plans may help with the other 20%.

Your home oxygen supplier must maintain and repair the equipment throughout the whole contract.

Can I decide which brand of oxygen equipment I receive?

You can ask your home oxygen supplier for a particular brand of equipment. You can also ask about issues such as equipment reliability, noise, and the cost of running the equipment for specific brands of equipment. However, your home oxygen supplier is only required to provide you with the oxygen delivery system prescribed by your provider. The specific brand that you receive from your home oxygen supplier will depend on what they have in stock. Before you enter into a Medicare contract with an oxygen company, ask your healthcare provider to make sure the equipment offered by the home oxygen supplier is correct for you.

Do I still receive oxygen supplies like tubing and face masks from my home oxygen supplier after the first 36 months of my Medicare contract?

Yes. Your home oxygen supplier is still responsible for providing supplies like tubing, face masks, regulators, and filters during the last 24 months of a five-year contract. They must also provide tank refills. And they must service and repair your equipment.

Can my home oxygen supplier decide to stop providing my equipment and services?

Under Medicare guidelines, your home oxygen supplier is obligated to continue to provide your equipment and services for the length of the five-year contract.

What happens if I move during the five-year Medicare contract?

Your home oxygen supplier is required to continue to provide service to you either directly or by contracting with another home oxygen supplier for the rest of the five-year contract.

Who owns the equipment when the five-year Medicare contract ends?

The home oxygen supplier owns the equipment both during and at the end of the five-year contract.

Can my home oxygen supplier change the type of supplemental oxygen system I am receiving during the five-year Medicare contract?

Your home oxygen supplier cannot change the type of oxygen system that you receive unless your healthcare provider orders the change and you approve it. Additionally, your home oxygen supplier cannot change the number of tanks that you receive unless your healthcare provider orders the change and you approve it.

What happens if my oxygen needs change during the five-year Medicare contract?

Talk with your healthcare provider if you notice a change in your oxygen needs and keep up with recommended medical appointments. Your healthcare provider will change the “Certificate of Medical Necessity” as needed and the home oxygen supplier is required to provide the equipment and service to meet your medical needs.

What happens at the end of a five-year Medicare contract?

Medicare requires that your home oxygen supplier alert you when you are getting close to the end of the five-year contract period. You may choose to remain with the same supplier or switch to a different supplier. If your home oxygen supplier no longer chooses to supply your equipment, they must help to find a new supplier for you. If they cannot find a new supplier for you, they must continue to provide your equipment and service.

Your healthcare provider will then need to complete a new “Certificate of Medical Necessity.” Remember – before you enter into a Medicare contract with a home oxygen supplier, ask your healthcare provider to make sure the equipment offered by the supplier is correct for you.

Does Medicare allow the home oxygen supplier to provide me with used equipment?

Yes. The equipment must be in good working order

Traveling with Supplemental Oxygen

Many people with pulmonary fibrosis (PF) can safely travel by air, but for some, air travel can be dangerous. The atmosphere is made of 20% oxygen and 80% nitrogen whether you are at sea level or living high up in the mountains. But at higher elevations, there is simply less air (the atmospheric pressure is lower), so there is less oxygen for you to breathe.

Since commercial airplane cabins are usually pressurized to an elevation equivalent to about 1,500-2,500 meters (about 5,000-8,000 feet), you will be breathing less oxygen while in-flight. Many people with PF can safely travel by air, but for some, air travel can be dangerous.

If you have PF, it is important that you discuss your travel plans with your health care provider weeks or months before planned travel. After completing any required medical tests, your healthcare provider will determine whether you need oxygen while in-flight. You will then need enough time to notify the airline, have your doctor fill out paperwork for the airline, and coordinate with an oxygen supplier.>

Do I need to bring oxygen on the plane?

You might need to use oxygen during your flight, even if you do not use oxygen at home. Your healthcare provider can help determine whether you need oxygen on the plane.

Some tests that your doctor might order include:

  • Pulse oximetry to check your oxygen level
  • Six-minute walk testing
  • Pulmonary function testing
  • Arterial blood gas measurement to check your oxygen and carbon dioxide levels
  • Echocardiography
  • “Hypoxia altitude simulation test” (HAST) – a test where your doctor measures your oxygen level while you breathe air with a reduced oxygen level (15% oxygen instead of 20%).

Based on these test results, your doctor might prescribe oxygen for you to use on the plane. If your oxygen requirements are too high or if you have other medical conditions, your healthcare provider may instead advise you to not travel by air, since your oxygen levels may drop dangerously low in-flight.

Will the airline supply oxygen if my doctor prescribes it?

In the United States, airlines are required to allow passengers to use battery-powered portable oxygen concentrators that have been approved by the Federal Aviation Administration (FAA).

Most airlines require you to bring your own portable oxygen concentrator, but not all concentrators are allowed by all airlines. Each airline maintains a list of which portable oxygen concentrators they will allow on board. A small number of airlines will provide you with oxygen on board. There is usually a charge to use an airline’s oxygen. Airlines will not allow you to bring filled oxygen tanks (green cylinders) or liquid oxygen onto the plane.

Your healthcare provider must complete paperwork ahead of time that instructs the airline about how and when you should use oxygen. Your healthcare provider can also help to arrange for a short-term oxygen concentrator rental from an oxygen supply company.

Checklist for Traveling with Oxygen

  • Prepare weeks or months ahead of time. See your doctor and notify the airline as early as possible. While some airlines may only need 48 hours of advance notice, it is advisable to prepare much earlier.
  • Be aware of the airline’s specific requirements regarding which oxygen concentrators are allowed and what paperwork is required. Contact your airline for further information.
  • Be sure to bring enough batteries – and make sure they are fully charged! The FAA requires you to have battery life equal to 150% of your expected travel time. You should also factor in time needed to travel to the airport, waiting to board, layovers, and traveling from the airport to your destination after arrival. The airplane may or may not have an electrical outlet available if your batteries run out.
  • Ask your doctor if you should monitor your oxygen level in flight with a portable pulse oximeter.
  • If you are traveling outside the United States, different regulations may apply. Contact your airline for guidance. And remember to bring the correct electrical plug adapter for the country you are visiting.

What else should I know when I travel by air?

If your condition has worsened or you feel ill on the day of travel, you should talk to your doctor about your travel plans. Talk to your doctor to see if you should bring extra medication on your trip. Many people are more active while traveling. You may find that you are unable to participate in some activities that require a good deal of effort. Consider this possibility when planning your trip.

Can I travel to high elevations?

It is important that you discuss your travel plans with your healthcare provider. If your destination is at an elevation above sea level, you may suffer from breathlessness with small degrees of exertion or even while resting. Your healthcare provider may advise you to not travel to destinations at high elevation.

What about traveling by car?

Contact your oxygen supplier to tell them about your travel plans and your oxygen needs at your destination. The 12V DC outlet power source charger in your vehicle can charge your portable oxygen concentrator.

My doctor said I need oxygen at my destination. How can I obtain oxygen while away from home?

Your doctor may determine that your portable oxygen concentrator is sufficient for your travel needs while away from home. If you need an additional oxygen delivery device while away from home, your oxygen supplier may be able to coordinate with an oxygen supplier at your destination to provide the device(s) you need. Be sure to plan ahead of time.

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