It is not uncommon to see someone in public wearing an oxygen system. Portable oxygen products have responded to patients’ needs for a lightweight, long-lasting, and somewhat fashionable piece of equipment. Historically, oxygen products were extensions of industrial packaging for home oxygen products and looked like welding supply accessories.

There is a new generation of oxygen patients that is younger, more informed, and interested in finding products that meet their lifestyle needs. It is estimated that the number of oxygen patients in the United States will double in the next 20 years due to the Baby Boomer generation entering their 60s and the legacy of a smoking habit. Manufacturers see the opportunity to respond to their oxygen needs and promote products directly to patients for use with normal daily activities.

What do oxygen patients want? The same things people without oxygen want: to live a normal life and get the supplemental oxygen their body needs without obstacles. They want to go places without limitations and be treated with respect.

Getting Oxygen to the Patient
In home care, the issue has been determining the patient’s needs and finding the most efficient delivery system for those needs. Research shows that providing oxygen as early as necessary prevents complications and extends patients’ length and quality of life. Several decades ago, this was not the case and patients were prescribed oxygen as a last resort and usually on their death bed. Now, patients are diagnosed early in their disease process and can be prescribed long term oxygen therapy (LTOT) as young as 40 years of age. This means that the young patient could have 20 more years of productive work and a 30- to 40-year life on LTOT.

Oxygen products have responded to this change in the type of patient. Stationary oxygen has evolved to a level where current systems are efficient and cost-effective. Typically, a concentrator is the product of choice for stationary oxygen, and liquid oxygen (LOX) is used for special circumstances such as high flow or transfilling a LOX portable.

Portable oxygen has been the target of debate from all segments of the LTOT industry with issues related to patient needs, product capabilities, and reimbursement. The portable oxygen system is the key to activities of daily living (ADLs). A portable system needs to oxygenate the patient at all activity levels, be light enough to carry, and last long enough to allow for a reasonable operating time.

Each market segment has a different opinion on the definition of a portable oxygen system, with payors having the greatest impact on products and availability. You would think the patients would be the final decision makers, yet that is not the case today. Some oxygen products have created a consumer demand for product sales, access, and availability—so the times may be changing.

New portable oxygen systems have created an opportunity for patients to do more ADLs with ease and comfort. Oxygen conserving devices (OCDs) have been added to most portable systems, and they can reduce weight and extend operating time. Patients that can tolerate an OCD use their oxygen more efficiently so the oxygen they carry is not wasted.

Patients should be tested at all activity levels when using a portable and/or OCD because each device operates differently. Again, clinical effectiveness needs to be the first priority for LTOT.

Robert McCoy

Worth the Weight
Weight is one of the new features of portable oxygen systems. Last year’s LTOT Consensus Conference recommended that a portable oxygen system be 10 pounds and operate 4 hours at 2 lpm. That was a challenge in the past, yet the new standard appears to be a four-pound portable that lasts 4 to 6 hours at a 2 setting on the OCD. This was a subject of discussion at the LTOT Consensus Conference held on August 26-28 in Denver (see www.ltotnet.org for more information).

There are compressed gas systems that operate with an OCD that weighs four to six pounds and lasts 5-plus hours. New concentrator systems are available that can fill cylinders from the concentrator, which allows the patient to control the availability of full cylinders.

LOX portables carry more oxygen in a smaller space so they can last a little longer than a compressed gas system on a similar setting. New LOX refill bases (that can be taken with the patient) are available that hold 10 liters of LOX and weigh 50 pounds full. Yet another new concentrator system can fill a LOX portable from liquefied oxygen generated by a concentrator.

Portable oxygen concentrators provide a new option of never running out of oxygen as long as there is an electrical source available. These systems weigh 10 pounds and can operate from 1 to 3 hours on battery.

Oxygen on the Patient
Most care providers do not think much about putting oxygen on the patient, and a standard cannula is the first choice. Patients, on the other hand, care a great deal about comfort and appearance. Until you have worn a cannula, you don’t know what it feels like. There are critical issues of comfort and compliance.

A cannula is a piece of plastic that sits on the skin and is a length that is convenient for the system being used. There are multiple options for cannula length ranging from three feet for a portable to 100 feet on a base unit. Swivel adapters are available to prevent twisting and kinking, which is a frustration for many patients with longer tubing.

There are cannula options that address the material and shape of the tubing. One manufacturer has developed silicon tubing that is softer than plastic, but can be easily kinked. There are patches that can be used where the cannula touches the skin, plus foam that can be used for over-the-ear discomfort.

Oxygen glasses are a novel way of hiding the cannula in the frames of the glasses. The glasses cost the same as normal glasses, and the prescription can be filled at a local eyeglass retailer. These glasses virtually hide the oxygen tubes on a patient’s face and are very discreet. Many patients have commented that when they started using the glasses, their friends thought they were off the oxygen.

This increase in self-esteem further enhances a patient’s desire to do ADLs and get out of the house more often. These glasses have been on the market for many years, yet patients comment that they never knew they existed and were never told of this option.

Carrying oxygen can be an issue for a patient that is already limited by low oxygen levels. Lightweight oxygen systems have helped, yet there might be more to help the patient. One manufacturer has developed a carrying strap that is made of a material that stretches and acts as a shock absorber for the portable. It makes the portable feel lighter even without the reduction in weight.

In the past, patients developed their own carrying cases for oxygen portables to hide the fact that the units were not pretty. Now manufacturers are responding with functional, safe cases that look better. Maybe oxygen will be a fashion statement in the future as more people are seen on oxygen and a “celebrity” wears one in public?

Celebrity or no celebrity, if a product does not meet needs for ADLs, patients are not going to wear the product. Therapy cannot be mandated. Instead, education and the right products will gain compliance

Manufacturers must continue to do a better job of developing oxygen products that are functional, fashionable, and available for LTOT patients. Providers need to do a better job of investigating options for LTOT products that include accessories and options to live a normal life. Patients want to continue ADLs and maintain their quality of life. Someday in the future, oxygen may be as common as eyeglasses and hearing aids.

Robert McCoy, RRT, is managing director of Valley Inspired Products Inc, Apple Valley, Minn. McCoy can be reached via e-mail: bmccoy@inspiredrc.com.