Oxygen therapy at night and after physical stress despite normal blood gases at rest

Vraag

Hello,
I am suffering from CF and I am now 41 years old. Unfortunately my lung function deteriorated rapidly in last years, particularly dramatic over the last six months (FEV 1 now only around the 41 % to 45%). At rest I have still a relatively good oxygen saturation (around 94%). However, under physical stress, I run very quickly out of power. I feel I would be better of with an oxygen concentrator at home, maybe I could recover from a physical stress by lying down and taking supplemental oxygen (2 litre/min.) for a few hours or also at night. In my case you cannot clearly decide for or against supplemental oxygen. I think, the health insurance company would reject to pay for an oxygen concentrator due to my good blood gases at rest, on the other hand my blood gases were never assessed under physical stress, which would certainly lead to different conclusions. Now my question: If the health insurance company rejects an oxygen concentrator, I would like to buy one privately (I know, thoses devices are expensive!). Is there any concern from the medical point of view to take supplemental oxygen (2 l/min) after physical stress or at work even with normal blood gases at rest? I also perceive intelectual work as very hard and would like to have an oxygen concentrator at work (in the office). I believe that with supplemental oxygen I would feel much better and could better cope with my daily affairs. Can I do any harm to my body with such an early start of an oxygen therapy? I would be happy for an answer to my questions. Many greetings and thanks.

Antwoord

Dear questioner,
Apart from its costs, an oxygen therapy is not free of potential risks (e.g. inflammatory reactions in the lung) and therefore requires a critical and detailed evaluation of the indication to start the therapy, and a close monitoring thereafter. Therefore, the medical use of oxygen always presupposes a thorough and critical examination of the indication.
If not yet performed, the cause of your recent complaints has to be evaluated, ideally in close co-operation with your CF-care center. In respect to your recent "dramatic deterioration", it is insufficient to appoint the symptoms simply to "natural process of the CF disease", but potential differential diagnoses have to be excluded (e.g. by a detailed examination by your CF physician). Even if it turns out that your complaints result from progression of CF-lung disease, it has to be evaluated whether your past therapy can be further extended or optimized. Supplementation of oxygen can only be a component of a rather holistic treatment concept.
Most studies on long-term oxygen therapy (LTOT) were accomplished in patients with chronic bronchitis (COPD) and can only be transferred to CF patients with reservations. Secured indications are actually heavy impairment of gas exchange at rest, under physical stress or at night. With normal blood gases at rest but subjective complaints under physical strain as described by you, it is advised to perform standardized measurements of your heart and lung function during physical exertion and during night sleep. It can be advantagageous to accomplish a thorough check-up during a short stay in a specialized hospital. As a function of the results the treating physician will decide from which measures you will particularly profit. Only if he sees the medical indication for a LTOT, the cost transfer should be discussed with the responsible health insurance company.

We strongly dissencourage a self medication with oxygen, apart from the relevant costs also due to potential side effects!
Yours sincerely
TO Hirche

07.11.2007