Dear COPD Coach,
I get so short of breath when moving and during most activities; can I increase my O2 liter flow?
–Out Of Breath
Dear Out of Breath,
A lot of COPD patients are first given a prescription of oxygen at 2 liters per minute (lpm) by their doctor when it is determined that they could benefit from supplemental oxygen, and for many people, 2 lpm is enough. For some folks this is not sufficient. They may require more oxygen especially for activity. It might seem easy to dial your O2 setting up or down, but keep in mind that oxygen is a prescription medication just like any other, and changing the dose you receive is actually violating the doctor’s orders. The best way to define oxygen use is to check oxygen levels during a 6 minute walk or during a test called an “oxygen titration test.” If these tests are not available you can check your own oxygen level using a pulse oximeter. These devices are available on line and even in some drug stores
To start, you should know your “resting” saturation (what your number is when you’re sitting down and not exerting.) It should be in the 90’s. Then, when you are feeling short of breath, put the oximeter on your finger and find out your saturation. (It is good for every oxygen patient to have a pulse oximeter, but as with any medical test, you should know how to interpret the numbers and be smart about the decisions you make with that information!)
If it is less than 88 you just may need more liters per minute. Ideally, anytime you feel short of breath you can sit down and breathe slowly and return to a saturation above 90 quickly.
Many patients learn about their upper and lower limits for oxygen liter flow in Pulmonary Rehab classes. In that setting you are monitored by a lung therapist and your oxygen is adjusted to a level that permits you to exercise safely. The therapist at rehab will usually inform your doctor of the need for additional oxygen during activity.
With the permission of your doctor, you can test this out at home if you are not participating in a rehab program. For me, I know that showering and washing my hair, for example, requires a higher liter flow as does walking at a pace that’s fast enough to benefit my heart and lungs. So actually my settings vary from 2-4 liters and my doctor is aware of this and has made my oxygen supplier aware of it as well. Because I’m informed, I have his permission to dial up and down as needed.
Shortness of breath is not always an accurate indicator of your oxygen level. Oxygen problems are only one cause for shortness of breath. It is worth remembering that oxygen like any other therapy can cause problems. Some people need to keep their O2 readings at 92 or below. This occurs when an individual has a poor exchange rate for oxygen and CO2 and therefore is a CO2 retainer. (Retaining too much Carbon Dioxide (CO2) can be dangerous!)
Your Pulmonary Function Test and an Arterial Blood Gas Test are used to determine whether or not you are a retainer. Another factor that must be considered is that there is a very fine line between panic and shortness of breath. In fact, the two can spiral together, panic leads to SOB which further increases panic. In this case, your oxygen level might be safe, but you’re still gasping for breath, so dialing up really won’t help. Do not be afraid to ask your doctor to add an anxiety medication to your treatment. This, too, can be an enormous help.
The more you understand about your oxygen needs and how to treat them, the better off you’ll be!
Thanks for writing,
Ask the Expert is aimed at providing information for individuals with COPD to take to your doctor, and is not in any way intended to be medical advice.
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