Oxygen therapy for pulmonary fibrosis

Understanding oxygen therapy for pulmonary fibrosis

Oxygen therapy is vital in managing idiopathic pulmonary fibrosis, a condition marked by progressive scarring of lung tissue. For those affected, supplemental oxygen eases breathing difficulties, enhances activity levels, and boosts overall well-being. By providing oxygen-rich air, this therapy alleviates breathlessness, supports pulmonary rehabilitation and maintains lung function, thus improving quality of life.

Every cell in our body relies on oxygen to function effectively. In pulmonary fibrosis, compromised lung function leads to inadequate oxygen levels. The terms hypoxia and hypoxaemia both refer to issues with oxygen levels in the body, but differ in their specific meanings and locations.

Hypoxaemia

• Refers to low oxygen levels in the blood, specifically in arterial blood (hypo=low, ox=oxygen, aemia=blood).

• It is a measurable condition typically determined using blood tests, like arterial blood gas (ABG) analysis, or non-invasive tools like pulse oximetry.

• Common causes include lung diseases (eg. pulmonary fibrosis), high altitudes or impaired oxygen exchange in the lungs.

Hypoxia

• Refers to low oxygen levels in the body’s tissues or organs.

• It can result from hypoxaemia, but also from other factors like poor blood flow (ischaemia) or the inability of cells to use oxygen (eg. in cyanide poisoning).

• Symptoms depend on which organ or tissue is affected, such as confusion (brain hypoxia), chest pain (heart hypoxia), or muscle fatigue.

Relationship between them

• Hypoxaemia can lead to hypoxia because insufficient oxygen in the blood reduces the oxygen available to the body’s tissues. In general, this is the case with pulmonary fibrosis

• However, hypoxia can occur without hypoxaemia, such as when blood flow is restricted despite normal oxygen levels (eg. a blood clot). This is less common in patients with pulmonary fibrosis.

Both conditions are serious and require medical attention, as they can significantly affect overall health and organ function. Oxygen therapy ensures sufficient oxygen reaches the bloodstream, reducing breathlessness and improving every day activities. Whether for home use or exercise, this therapy becomes an important support system.

Regular assessments of oxygen therapy’s impact on quality of life are crucial. They help determine the therapy’s effectiveness and identify any necessary adjustments to meet individual needs, ensuring patients receive the full benefit of their regimen.

Signs you may need supplemental oxygen

Acting quickly is important to determine when someone might need extra oxygen. Look out for common symptoms, including shortness of breath, fatigue, irritability, blue fingertips or lips, a rapid heart rate during activity and swollen ankles, as these could mean low oxygen levels that can seriously impact health and daily life.

In pulmonary fibrosis, breathlessness can occur even with normal oxygen saturation due to lung stiffness. Additional signs of low oxygen include headaches, weakness, chest pain and fainting. Monitoring tiredness and breathing rate, especially during physical activities, can help identify the need for supplemental oxygen.

How oxygen therapy works

Oxygen therapy is a life-changing treatment for those with pulmonary fibrosis. It involves delivering oxygen through nasal tubes or a mask connected to a machine, ensuring oxygen travels from the air sacs in the lungs into the bloodstream, thereby improving oxygen saturation levels.

Long tubes from the oxygen machine allow patients to move around their homes while staying connected to their oxygen supply. This flexibility helps maintain adequate oxygen levels, enabling more active and fulfilling lives despite their condition.

Types of oxygen equipment

Choosing the right oxygen equipment is essential in oxygen therapy. Various systems, including home oxygen concentrators, portable oxygen concentrators and oxygen tanks, cater to individual needs. Each device has its own features and advantages to help manage oxygen levels effectively.

Home oxygen concentrators

Home oxygen concentrators are designed to provide a continuous supply of oxygen for individuals with respiratory conditions. These devices are typically larger, about the size of a mini-fridge, and heavier and can generate up to 15 litres of oxygen per minute, making them suitable for continuous use in a home setting. This ensures that patients receive the oxygen they need throughout the day and night, significantly improving their quality of life.

Home oxygen concentrators take the 21% oxygen in the air and increase it to 90%-95%, helping to manage low oxygen levels and keep this steady and at an adequate level—which is essential for those with pulmonary fibrosis.

Portable oxygen concentrators

Portable oxygen concentrators are game-changers for active individuals. Designed for use outside the home, they allow users to maintain mobility and engage in daily activities without being tethered to a stationary machine. Ambulatory oxygen therapy (AOT), using portable oxygen devices, is especially beneficial during exercise or physical activities.

However, be cautious of over-the-counter portable oxygen concentrators, as they may not meet the oxygen needs required for managing lung disease like pulmonary fibrosis and always consult with your respiratory team.

Oxygen tanks

Oxygen tanks, available as compressed gas in metal cylinders or as liquid oxygen stored at extremely low temperatures, are vital for managing breathing difficulties associated with pulmonary fibrosis. These pressurised containers ensure a reliable supply of oxygen for patients. Liquid oxygen is used for those that use a lot of oxygen over a short period.

Patients usually use oxygen tanks with a mask or nasal tubes (cannula) to ensure they get the right amount of oxygen as prescribed. To keep them working well, regular maintenance is essential to check for leaks and to make sure the tank is secure.

Getting an oxygen prescription

Obtaining an oxygen prescription starts with a detailed check-up by healthcare professionals. For people with idiopathic pulmonary fibrosis, oxygen needs should be reviewed at every follow up visit and before leaving the hospital after a flare-up to make sure the appropriate treatment matches their condition and activity levels.

The process includes looking at symptoms like breathlessness, blood gas tests and a clinical review. A key part is the six minute walk test, which measures how much someone can exercise over a six minute period which will enable the healthcare team to decide whether extra oxygen is required.

Regular check-ups help make sure oxygen therapy continues to work well and meets the patient’s changing needs.

Monitoring your oxygen levels

Monitoring oxygen levels is fundamental for managing pulmonary fibrosis effectively. Using tools like a pulse oximeter, patients can regularly assess their oxygen saturation to ensure it remains within a healthy range. Normal resting saturation is typically between 95% and 100% at sea level; readings of 88% or lower may indicate the need for supplemental oxygen.

A drop in oxygen saturation below 92% signals a potential risk of hypoxia, which can be dangerous if not addressed promptly. Regular monitoring helps identify when adjustments to oxygen therapy are needed to maintain adequate oxygen levels and overall health, ensuring the levels remain stable.

Some patients with longstanding hypoxia may need to keep their oxygen saturations at 88-92% to prevent excess CO2 retention. Your health care provider will tell you what is the optimal level for your oxygen – either 88-92% or 94-98%

Tips for using oxygen therapy safely and effectively

Using oxygen therapy effectively starts with knowing how to properly operate and care for the equipment. Typically, a technician will set up the oxygen concentrator and provide instructions for use. Safety is essential and taking the right precautions can help prevent accidents and ensure the effective use of oxygen. Follow these guidelines:

• For stationary oxygen concentrators, ensure the device is continuously plugged in.

• Check the oxygen tubing regularly to make sure it is not twisted or damaged, as this could block the flow of oxygen.

• Keep equipment away from heat sources and open flames to reduce the risk of fire, eg. radiators, gas cookers, candles, electrical charging equipment.

• Keep equipment away from flammable liquids, such as paint thinners.

• Use water-based skin products instead of oil-based ones, as oil-based products can be flammable when used with oxygen.

• Turn off the oxygen supply when not in use to minimise fire hazards.

• Quit smoking for at least 6 months before starting home oxygen therapy, as smoking poses serious risks.

• Be mindful of trip hazards with oxygen tubing.

• Store oxygen tanks in a well ventilated area and inspect for leaks.

• Handle liquid oxygen carefully to avoid cold burns.

• Ensure your smoke alarms are working properly!

Please refer to the guidance provided by your oxygen supplier as the above list is not a full list of all the precautions.

Remember that, if you use oxygen at home and are going on holiday, you will need to organise oxygen in advance at your holiday location and on your flight if travelling abroad.

Pulmonary rehabilitation and oxygen therapy

Combining pulmonary rehabilitation with oxygen therapy provides a well-rounded approach to managing pulmonary fibrosis. This program helps improve daily activities, effectively controls symptoms, and reduces intense breathlessness. Exercise training improves respiratory muscle strength and overall endurance, making it easier to manage the condition.

Oxygen therapy alleviates the strain on the body’s vital organs and improves oxygen delivery, providing extra oxygen to patients. Many patients find that this combination significantly enhances their quality of life, allowing them to engage in physical activities like jogging, walking and sports with their doctor’s approval.

Palliative care and advanced stages of pulmonary fibrosis

For advanced pulmonary fibrosis, early referral to palliative care can significantly improve symptom management and overall quality of life. Palliative care can be provided in hospitals, outpatient clinics or at home, depending on the patient’s preferences and needs.

A palliative care plan is established based on the patient’s wishes in collaboration with their doctor or healthcare team. This approach ensures that the patient’s comfort and quality of life are prioritised as the disease progresses.