Q: Many of my home care patients have oxygen ordered. I feel like some of them wear it too much and get dependent on it. How should I teach them to use it properly?

Thank you for this important question. There are many misunderstandings about home oxygen use. Oxygen is not addictive, and the body does not build up tolerance to oxygen. Every single organ in the body depends on it, and some are very sensitive to a lack of oxygen. One of the chief benefits of supplemental oxygen is it can slow or prevent some of the complications associated with chronic hypoxemia, such as pulmonary hypertension and right-sided heart failure. Having patients wear their oxygen too much is not usually the problem-it can be much more difficult to convince patients who do not want to wear oxygen that they need it to protect their organs from the effects of hypoxemia.

Getting a patient to accept home oxygen is part of the educational process. Teaching your patients that oxygen can improve survival and quality of life (Anderson et al., 2013) and exercise performance (Criner, 2013) will help them understand that oxygen provides health benefits. The availability of low cost and accurate finger oximeters can improve proper use of home oxygen by allowing patients to see their saturation numbers with and without supplemental oxygen, while at rest and with activity.

Will oxygen relieve shortness of breath? Every patient is different, and this depends on the exact reason oxygen is being prescribed. If your patient has been dealing with shortness of breath long before they required home oxygen, they may not notice much relief. This does not mean the oxygen is not working or needs to be at a higher flow rate. Oxygen is not capable of reversing lung or airway damage associated with chronic lung disease.

There are plenty of negative aspects to using home oxygen. Many people are self-conscious, not wanting to draw attention when out in public. The tanks or other portable devices can be heavy, making patients less likely to want to leave the house. Newer options have made traveling outside the home with oxygen much easier, but many insurers will not cover this new technology. Some patients may still smoke cigarettes, or have family members who do, and are worried about potential safety concerns. I have had patients worry needlessly that their oxygen concentrator would use up all the oxygen in their home and other patients fear that it will explode. Any of these can result in a patient not wanting to use their home oxygen. We need to be consistent with teaching and information, so that we give patients the best chance of continuing this important treatment. Along with stressing the importance of supplemental oxygen, we also need to make sure patients know how to use it safely. Caution patients not to increase the flow rate of their oxygen above what was ordered by their physician. Proper education, both before oxygen therapy is started at home, as well as any time during the process is imperative. The durable medical equipment company that supplies your patient's oxygen can tell you precisely how the primary care provider ordered it to be used. They are also responsible for ensuring that the patient and caregivers are educated on safe use and storage of oxygen. If there is any concern that the patient does not understand safe use of their oxygen delivery system, notify their durable medical equipment company.

-Mark M. Courtney RRT, NRP, AE-C, CTTS

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