As our aging population moves into the years where respiratory support is often necessary, the demand for long-term oxygen therapy continues to grow. Estimates on the number of patients who currently require oxygen vary from 750,000 patients, identified by the American Association for Respiratory Care at a 1999 consensus conference in Cancun, Mexico, to more than 1.2 million patients detailed in a September 21, 2001, Frost and Sullivan report on the US oxygen therapy devices market.

Long-term oxygen therapy is really a label for portable oxygen. According to the 3rd Oxygen Consensus Conference held in Washington, DC, in 1990, more than 80% of long-term oxygen therapy patients are ambulatory. This makes sense since most patients who are not or cannot be mobile have either a disease that is going to improve or a terminal illness that will progress to its final outcome rapidly.

While the need for ambulatory oxygen is rising, reimbursement is falling. This creates a challenge for the home health care industry. It must find ways to meet the growing demand for lightweight, long-lasting oxygen systems while controlling costs to maintain profitability.

Oxygen-conserving devices were the first to provide an option for small portable systems. Although manufacturers initially integrated these devices into liquid oxygen portables, the real growth in oxygen-conserving devices has been associated with small compressed gas systems. The market now has more than 15 different product options for oxygen conservation with a range of configurations and features to meet patients’ needs.

However, our research has found that different conserving devices provide different oxygen doses at the same number settings. Therefore, the provider must know how a device works and test the patients at different activity levels to ensure proper oxygenation.

Conserving devices are now incorporated into most of the new options for small, portable oxygen delivery equipment. But these devices work differently than continuous-flow devices, and the concept of oxygen-conserving devices and continuous-flow devices being equal is confusing and misleading. None of the oxygen-conserving devices that we studied on a test lung were equivalent to continuous-flow devices at different breathing patterns.

Keeping Cost Under Control
Another problem is that while patients benefit from the new lightweight ambulatory oxygen systems, providers find that this equipment costs more and impacts profitability in a capped reimbursement environment.

Two manufacturers have addressed the cost problem by reducing the expense of delivering oxygen to the patient’s home with concentrators that fill cylinders. The devices were introduced in 1999, but providers have been slow to embrace these home-filling systems for a variety of reasons.

As with all new products, there were technical difficulties that affected the first units on the market, and most providers tend to avoid being the pioneers that get caught with early mechanical failures. Another reason was sticker shock. These systems cost more than $2,500. The typical cost of a concentrator is around $650. Because the home-filling system is a novel program with many parts, not all providers understood that it was more than just a fancy concentrator.

Manufacturers offering home-filling systems have financial analysis tools that can help the provider understand total costs. If a provider is meeting the needs of ambulatory patients, these home-filling systems can reduce expenses and improve profitability.

Another manufacturer recently received US Food and Drug Administration (FDA) approval for a system capable of taking oxygen from a concentrator, liquefying the gas, and filling a liquid oxygen portable. This will allow providers to supply the new lightweight liquid oxygen portables without the associated cost of delivering liquid oxygen to the home. The economics will be similar if this product is priced in the same range as the gas home-filling systems.

Concentrators to the Rescue?
Another option for portable oxygen in the home without the need for deliveries of separate systems is the portable concentrator. The clinical community has recommended portable concentrators for years, yet until recently manufacturers have not had enough incentive to invest in their development.

One manufacturer recently received FDA approval for their portable oxygen concentrator system. The unit was shown at Medtrade in October and Medtrade Spring in April and should be available in the near future. Another manufacturer has collected customer feedback for their portable concentrator, but has not announced FDA clearance.

The ideal portable concentrator weighs less than 10 pounds and lasts 3 to 4 hours on battery power. It must also meet the patient’s oxygen needs during rest, sleep, and exercise. Current units do not meet that specification, but the first step in product development has begun. It may be only a matter of time before we will have a single-source system for patients to use at home and away from home.

What Lies Ahead
Increased awareness of the growing oxygen needs of an aging population has stimulated novel and futuristic research. Currently, oxygen is liquefied for storage and delivered to the patient in cryogenic containers or packaged as a gas for storage in cylinders. Concentrators generate oxygen using pressure swing absorption (PSA) technology, which has been available for more than 20 years.

Research is focusing on new concepts that use ceramic technology and electrochemical technology. These approaches have proven concepts for generating oxygen, yet it will be a while before they will be commercially available.

The goal of new technology is to create small lightweight oxygen systems that are practical and economical. In the future, with pollution and disease affecting our lungs and the air we breathe, oxygen therapy could become as necessary as communication. We may have oxygen systems that are as small as cell phones and worn by a majority of the population.

The Patient Perspective
Oxygen systems were created to meet the needs of patients and to treat their disease. But often industry has lost sight of the reason oxygen is provided. Distractions, such as the variety of products and reimbursement, have taken the focus off the patient. Trade organizations and associations have lobbied for reimbursement and held conventions to talk about the problems with long-term oxygen therapy. Rarely have they invited any patients to participate or advise on their issues and concerns.

“In the future, with pollution and disease affecting our lungs and the air we breathe, oxygen therapy could become as necessary as communication.” —Robert McCoy, RRT

A new organization, Emphysema Foundation For Our Right To Survive (EFFORTS), is raising the awareness of the patients’ perspective. EFFORTS has an informative Web site at www.emphyse ma.net and its list server connects more than 900 emphysema patients who chat about everyday issues they face. These patients are familiar with the Internet and can find product information and clinical research that they share with each other.

Since clinicians and providers are becoming busier every year, and limited time and money do not allow for the type of service the patients require, educated patients, such as EFFORTS members, can assist with their health care and be more involved with problem solving and options to meet their needs. At this time, the majority of long-term oxygen therapy patients are not at the level of EFFORTS members. However, as the number of oxygen patients familiar with the Internet increases, consumer-driven therapy may result.

Most industry watchers believe the number of patients who will require oxygen will double in the next 20 years and portable oxygen is the fastest-growing segment in long-term oxygen therapy. As a result, the industry is starting the process of changing to address the new issues. Manufacturers are developing new light-weight systems to provide options to patients and providers, new home-filling systems help to reduce costs associated with the delivery of portable oxygen, and the first portable concentrator has received government approval for introduction to the market. We will have new products, yet we need to discover new ways of providing service to long-term oxygen therapy patients, focusing on quality of care at the lowest cost. With this year being abbreviated 02, this is the year for oxygen.

Robert McCoy, RRT, is managing director of Valley Inspired Products, Burnsville, Minn, a technical, clinical, and marketing services company for respiratory equipment manufacturers. Contact him at bmccoy@inspiredrc.com.