The Road to Better Oxygen Therapy

This post was written by Michael W. Hess, MPH, RRT, RPFT

When I was joining the COPD Foundation in 2020, my boss offered me a mission. It was a bit different role than the one I had applied for, but it seemed like an interesting challenge.

"How would you like to help fix supplemental oxygen?"

Now, I've never been a durable medical equipment (DME) person. I was coming from a position in primary care where I WORKED with a lot of DMEs, facilitating prescriptions and coordinating care. I had a vague understanding of how much the industry had struggled over the last decade, with payment cuts related to the Medicare competitive bidding process. I knew many people had been having a harder and harder time accessing equipment that fit their lifestyle and health goals. I knew that a lot of my respiratory therapist colleagues had been forced to move on because of budget cuts and consolidation. I figured getting to the root causes of the issues and developing strategies to overcome them would be an interesting challenge.

I call that time "the good old days," because I was caught completely off guard by the sheer magnitude of that challenge.

It turns out that here in the United States, we've actually been slowly chipping away at our ambulatory oxygen therapy infrastructure for decades. Some types of equipment, like liquid oxygen, have become essentially extinct because they're too expensive to provide. That, in turn, means that while we clinicians keep telling people that one of the keys to improving quality of life with chronic breathing problems is staying active, the system cannot provide them with the means to do so. Frustration abounds on both sides of the stethoscope, not to mention with the suppliers whose hands are tied.

Compounding the issue are multiple knowledge gaps. Our understanding of the appropriate use of oxygen therapy is based on research published in the early 1980s using essentially homogenous patient cohorts from the US and the United Kingdom. In 2018, an American Thoracic Society workshop report found that many clinicians do not have the appropriate knowledge or resources to effectively prescribe oxygen equipment or to monitor the effectiveness of oxygen therapy. With prescribers unable to instruct people and DME suppliers often unable to provide clinicians in the home, training is often unfairly delegated to delivery technicians, and patients are left in the dark.

It's not just the ambulatory care world that faces challenges. The COVID-19 pandemic revealed and exacerbated major issues with oxygen delivery in acute care settings, too. Many hospitals simply could not keep up with surges in oxygen consumption related to the surges in COVID admissions. In some cases, that led to hospitals needing to divert patients elsewhere because their oxygen pipes were depressurizing to the point of freezing. In worse cases, it led to hospitals running out of oxygen altogether. Regardless of the setting, this critical lack of investment in infrastructure and preparedness has cost lives around the world.

But it doesn't have to be this way. The problems are undoubtedly substantial, but they are not insurmountable. That's why we are proud to be the lead organization for World Oxygen Day, an international campaign recognizing the entire oxygen therapy community. We have designated October 2nd (or “O-2”) as an annual event around which stakeholder groups in the world of oxygen can build campaigns for increased awareness, enhanced education, and community support. Last year's inaugural event focused on building networks and identifying partners, capped by the Oxygen Stakeholder Summit. The Summit brought together a pulmonologist, a DME RT, and two oxygen therapy users (one with pulmonary fibrosis and one with COPD) to share their experiences and viewpoints and identify ways to work together to break down barriers.

This year's event broadens the international scope of World Oxygen Day, as we will be promoting new resources from all over the world. We will be reviewing findings from this year's World Health Organization Road to Oxygen Access meeting in Dakar, Senegal and forecasting next year's Lancet Global Health Commission on Medical Oxygen Security report. We'll also be hearing from oxygen therapy users and other stakeholders about how oxygen therapy has impacted their lives so that the public can better understand the lived experience beyond stereotypes and stigmas. Closer to home, we'll be having a major push to contact Members of Congress to whip support for the Supplemental Oxygen Access Reform (SOAR) Act, legislation designed to start reversing the decades of neglect our DME infrastructure has faced. And we'll be promoting existing oxygen tools and resources because people cannot use tools they do not know exist.

We'd love to hear from YOU, too! There are plenty of ways to get involved, from holding a local event marking the day to recording a short video or sharing our social media materials. You can also sign up for our oxygen-specific e-newsletter (not spam, we promise!) for ongoing updates throughout the campaign and beyond. Let us know how you plan to participate in the comments or at oxygen360@copdfoundation.org!