How can I get a portable oxygen concentrator?

Dear Dr. Mahler:

I want to know your thoughts on a portable oxygen concentrator. I am 72 and have some trips planned this summer. Two people at my pulmonary rehab program have these and like them very much.

My doctor has told me that I have severe COPD, and I use two different inhalers. My oxygen is set at 3 on pulse with activities and when I exercise. When I sleep, I use a home concentrator at a setting of 2. I have talked to the company that provides my oxygen, but the man said that they do not carry portable oxygen concentrators. He said that I will have to buy one. Please help. 

Patrick from Albany, NY

Dear Patrick,

Your question about a portable oxygen concentrator is a frequent one that I receive in my practice. I will first address the situation how Medicare pays companies for providing oxygen to those who require it. This information helps you to understand how things work. Then, I will briefly describe some issues that you should consider if you decide to buy a portable oxygen concentrator. I will try to keep it simple even though is somewhat complicated.

How Medicare Pays for Oxygen

All types of oxygen are rented from a respiratory supply company. Once you qualify for oxygen by your health care provider, the company provides the oxygen to you, and then bills Medicare a monthly fixed rental fee. Medicare pays the oxygen company a monthly rental fee (from $140 to $200 per month depending on where you live) for 3 years and then a small “service fee” for the next 2 years. The oxygen company is required to maintain the equipment for a total of 5 years.

In 2013, Medicare reduced payment for portable oxygen concentrators by almost 50%. Due to this reduction in payment, many oxygen supply companies have told some individuals that Medicare does not cover a portable oxygen concentrator. The bottom line is that some oxygen companies do not believe that Medicare pays enough for the costs of a portable oxygen concentrator and therefore do not deal with them.

So, you should first talk to the respiratory supply company as you have done. If the company cannot provide the system, then you may consider buying a portable oxygen concentrator.

Types of Portable Oxygen Concentrators

Airsep Focus POC that weighs 1.75 pounds.

Airsep Focus weighs 1.75 pounds.

The key features that you should consider are: weight; type of oxygen flow – pulse or continuous; available oxygen flow rates; how long the battery lasts; and cost.

One of the smallest is called the Airsep Focus that weighs 1.75 pounds, allows 2 liter/min pulse flow, and the battery lasts 3 hours.

 

Respironics SimplyGo POC that weighs 9.5 pounds and can be carried over the shoulder.

Respironics SimplyGo weighs 9.5 pounds and can be carried over the shoulder.

 

A medium sized concentrator is the Respironics SimplyGo which weighs 9.5 pounds and can be carried with a strap over the shoulder. It provides pulse flow rates of 1 – 6 liters/min and continuous flow at 1 – 2 liters/min. The battery lasts about 3.5 hours at 2 liters/min pulse flow and 1 hour at 2 liters/min continuous flow.

 

 

Bigger oxygen concentrators allow higher flow rates and longer battery time. They can be placed

Front view of SeQual Eclipse 5 POC.

SeQual Eclipse 5 POC weighs 18.4 pounds.

Cart with wheels and handle to pull POC.

Cart with wheels and handle.

on a cart with wheels and can be pulled. One of the heaviest ones is the SeQual Eclipse 5 which weighs 18.4 pounds, allows 1 – 9 liters/min pulse flow and up to 3 liters/min continuous flow. Battery time is up to 5 hours if pulse flow is used and 2 hours for continuous flow.

 

These are only three examples of many available portable oxygen concentrators. You should consider which features are most important for your use. Also, you may wish to rent one from a respiratory supply company before buying.

Good luck on finding the best portable oxygen concentrator for your needs.

Donald A. Mahler, M.D.

 

Low Oxygen Level

My Oxygen Level was only 72%

Dear Dr. Mahler:

I recently had an incident where I did not feel well and checked my O2 level to find it at 72. I felt very short of breath, extremely shallow breaths and had a stinging pain in my head. Had been reading and had gone to the restroom. I had been fine while just sitting and reading. Was on steady flow not on pulse. I have oximeter checked frequently and it is always spot on. Found and corrected the issue immediately but do not know how long I had had levels below 90 before I realized I was not feeling well. Could my organs or brain been affected? At what level does damage to the organs and or brain occur?
Thanks
Cindy from El Paso, TX

Dear Cindy,

Sorry to hear of your problem, but at least it was temporary.

It is impossible to know if you had any damage to your brain or other parts of your body with the low oxygen level. However, based on your description, I believe that it is highly unlikely that you suffered any permanent effect. Our bodies are remarkable and adapt to brief periods of low oxygen by increasing breathing and increasing heart rate in an effort to compensate. It sounds like your body sent you signals of this problem as you became “very short of breath” and had a “stinging pain in the head.” Your experience is a good example of how we need to pay attention to the signals that our body sends to our brain. The challenge is to know when the message is urgent like “I can’t breathe,” and then we need to respond as you did, OR we just ignore the signal and hope that it goes away.

To answer your second question, remember that the goal of breathing oxygen is to maintain an oxygen saturation level of 90 – 92%. This is measured by a machine placed on your finger called a pulse oximeter.

pulse oximeter that measures oxygen saturation

pulse oximeter that measures oxygen saturation

 

 

 

 

 

Although a normal oxygen saturation level if 95% or higher, the cells in our body work fine if we are at 90%. I suspect that when your doctor ordered oxygen for you, he/she picked the flow rate (usually 1 – 4 liters/min) based on measurements from the oximeter. Usually, the nurse or technician adjusts the flow rate of oxygen at rest and during walking to achieve a saturation in the low 90s. Hopefully, your doctor, or nurse, will check you oxygen levels periodically as things can change.

Finally, even though you are using oxygen, I encourage to stay as active as possible.

Best wishes,

Donald A. Mahler, M.D.

Need Oxygen for Air Travel? Consider a Portable Oxygen Concentrator

Challenges of Using Oxygen for Air Travel

Dr. Mahler: 

I plan to fly to Tampa, Florida, to visit my daughter and her family for Christmas. My doctor told me that I have severe COPD based on breathing tests. I use a portable oxygen concentrator during activities at a setting of 2, but my doctor has said that I do not need to use oxygen when inactive or with sleep. Do you have any suggestions for flying? Do I need oxygen for air travel?

Daniel from Nashville, TN

Dear Daniel:

Planning ahead for air travel when you have COPD is important. Have you traveled by air in the recent past? If so, did you have any breathing problems?

If possible, take a direct flight rather have to stop at another airport. Make

Woman using oxygen for air travel

Woman using portable oxygen system

sure that you have a full supply of your COPD medications, and take your albuterol inhaler with you on the plane so it is available if you need to use it. Carry your COPD medications with you on the plane; you do not want your medications in a checked bag in case it is misplaced or lost.

Commercial airlines fly at altitudes of 30,000 to 40,000 feet, and the oxygen concentration is close to 15% rather than the normal 21% in the air that we breathe at sea level. You should ask your doctor whether you will need to use oxygen for air travel. Your health care provider may order a test in which you breathe 15% oxygen for 20 minutes in order to determine if your oxygen level falls below a certain value. This is called a “hypoxic challenge test.” You may need to go to a medical center to have this test done as most community hospitals are not set up to do such testing.

In general, if your oxygen saturation (measured with an instrument on your finger) is below 85% during the test, then using oxygen during the flight is recommended. If so, then you will need to notify the airline that your doctor has recommended that you use oxygen during the flight. The airline has a form that your doctor will need to complete. Then, you should submit the completed form to the airline medical department for review.

Concentrator provides oxygen for air travle

Portable oxygen concentrator (Respironics SimplyGo) that weighs 9.5 pounds

In April 2013, the Federal Aviation Administration issued a statement that a portable oxygen concentrator (abbreviated POC) can be used as a source of oxygen for air travel. Make sure that the airline knows that you are bringing your POC on the plane. The airline may allow you to use your own concentrator during the flight, or may provide their own oxygen system for you to use.

Hopefully, your travels will be smooth and uneventful. Enjoy the time with your family.

Best wishes,

Donald A. Mahler, M.D.