Q: I would like to know what can be done to relieve my breathing. How low does your oxygen level have to be before you need oxygen 24 hours a day? I have COPD and about two years ago I had a staph infection in my lungs. My breathing hasn’t been the same since. I would be very grateful if you could give me some kind of answer. Thank you very much.
A: For those readers who may not know what COPD is, I will begin by providing an explanation. Chronic obstructive pulmonary disease is a group of lung disorders that block the flow of air in and out of the lungs, making breathing difficult. The two most common conditions that make up COPD are emphysema and chronic bronchitis. Emphysema occurs when the air sacs in the lungs are destroyed and no longer function properly, causing the individual to be short of breath. Over time, the condition destroys the elastic fibers that hold open the small airways leading to those air sacs, allowing the airways to collapse during exhalation. In turn, this prevents the air from escaping easily.
Chronic bronchitis is inflammation of the bronchial tubes, the airways that carry air to the lungs. This form of bronchitis produces mucus, a productive cough, and difficulties moving air in and out of the lungs. The most common cause for the condition is the smoking habit that affects about 20% of smokers; however, it can also be the result of the inhalation of fumes in poorly ventilated homes, air pollution in the workplace, having a family history of the disorder, or exposure to second or third hand smoke. Third hand smoke is the material that remains on objects after the smoke has cleared.
Complications of COPD include an increased risk of heart disease, respiratory infections, hypertension, lung cancer and, while we may not think of it, depression which prevents COPD patients from enjoy the daily activities they once enjoyed.
Diagnosis can be tricky since the symptoms can mimic other conditions. A physician may choose to order a blood test for ABGs (arterial blood gases), an X-ray to confirm or rule out COPD, CT to help detect emphysema, and pulmonary function testing. A normal blood gas arterial oxygen level is between 80 and 100 mmHg. Normal oxygen saturation is 95 to 100%. There are specific criteria physicians use to determine whether (or not) as patient requires oxygen.
Treatment may consist of such medications as bronchodilators (inhalers), inhaled steroids to help reduce inflammation, combination inhalers and inhaled steroids, antibiotics, and others. Advanced cases may be treated with oxygen therapy that will deliver needed oxygen to the lungs. Without knowing how far advanced your COPD is, I cannot determine if you are a candidate or not. Some individuals use supplemental oxygen through portable units when they need to perform errands. Others may require it full time. Only you and your pulmonologist can make the decision when you will be best served by 24 hour therapy. Keep in mind that even when you are receiving treatment, there may be instances when your symptoms worsen. You might pass through an area of polluted air or develop a respiratory infection. Don’t ignore those times when your breathing is more compromised than it is at others. When all else fails, there’s the consideration of surgery that provides for the sectional removal of damaged lung tissue, or lung transplant.
In order for insurance companies to cover the expense, there are very specific criteria that must be met first that relate to the oxygen content in your arterial blood and the oxygen saturation reading received from a device placed on your finger. Remember that some individuals may not qualify for oxygen therapy while at rest but may require it when exercising, walking, or during sleep. Further, the therapy used during sleep or exercise must confirm improvement in your hypoxemia, otherwise it will be discontinued.
Until you and your physician reach a conclusion on your need for constant oxygen therapy, avoid known air pollution, first-second-third hand smoke, eat well, learn methods of breathing more efficiently, and see your physician regularly. Smoke permeates. Do everyone a favor by insisting your entire home and family be free of the habit.
Other readers who are interested in learning more can order Dr. Gott’s Health Report “Pulmonary Disorders” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
