When is a referral for oxygen therapy made?
You may have been diagnosed with a lung condition and have the right medication but still feel very out of breath.
It may be time for your health care professional to discuss if oxygen therapy could help you.
Before you are referred for assessment you will need a test, called pulse oximetry to make sure that an assessment for oxygen is right for you. If your oxygen level falls below a certain percentage, and your health care professional thinks oxygen therapy could help, you may be referred to the Home Oxygen Assessment and Review service.
If you are being referred by a hospital-based health care professional you may also be asked to take an exercise or walking test to assess your oxygen needs, particularly if it is likely you may only require ambulatory oxygen therapy. You may be asked to walk for six minutes up and down an indoor corridor or to climb a few stairs, or you may be asked to walk around some cones placed on the floor for a short period of time.
You should expect to receive:
- an appointment for assessment within six weeks of being referred
- a telephone call to confirm your attendance and that you are well enough for an assessment the day before the appointment
You will be asked about your smoking habits at your oxygen assessment and, if you do smoke, offered advice on quitting.
Who can refer you for oxygen therapy?
You can be referred for assessment by:
- your GP or practice nurse
- community services such as the community respiratory team, community matron or physiotherapist
- your hospital doctor (if you have been in hospital after a flare-up of your condition, or you are newly diagnosed with a lung condition)
- an occupational health department (if you work)
- a private health care provider
Where will I be assessed?
The assessment can happen in a variety of places. You can sometimes be assessed while you are in hospital and occasionally in your own home if your condition is very severe and this type of home service is available in your area.
How will I be assessed?
You will be assessed by a health care professional who will be able to administer the right amount of oxygen for you. This may be your respiratory nurse, a physiotherapist or occupational therapist either in the hospital or community.
At your first assessment you will usually also see a medical doctor who specialises in breathing problems. They will know the equipment provided by the local oxygen supplier. You will be advised who your first point of contact is for oxygen-related questions.
If you have not already had a pulse oximetry test, this will be done first to make sure you are suitable for the assessment.
The assessment will take up to an hour and a half.
You should expect:
- a spirometry test (if appropriate and if recent spirometry test results are not available)
- blood tests
- and sometimes an exercise or walking test
A spirometry test measures the amount of air you can forcefully blow out of your lungs in the first second of breathing out (FEV1), and the total amount of air you blow out in one breath (FVC). You will be asked to blow air out three times, with time to rest and recover between each. Your health care professional will stay with you to support you throughout the test.
You will have blood tests to measure how well your lungs can provide oxygen to your body and remove waste products such as carbon dioxide.
Blood is usually taken from an artery in your wrist and then pressure is applied to where the blood was taken from for several minutes to stop any more bleeding. Sometimes blood is taken from your ear lobe instead. The blood sample is sent to the laboratory to be tested while you wait.
Sometimes, you may then be asked to breathe some oxygen through a mask over your face, or through some tubing in your nose, for at least 30 minutes before a second blood test is taken.
In some cases, you may need a second appointment four to six weeks later for a second blood test. This is to check that you have consistently low levels of oxygen in your blood before a decision is made.
“Be sure you know why you’re being offered oxygen therapy and what delivery method is best for you. What would it mean to refuse? Also, importantly, don’t be ashamed of it. Wear it with pride. You’ll get a few funny looks but people in the main really want to be helpful and are very friendly”
- Jean, 69, who has COPD and asthma and uses ambulatory oxygen
Once the spirometry and blood test results have been reviewed you will be told whether oxygen therapy is right for you.
If the blood tests show that you have too much carbon dioxide in your blood, you may need to see a specialist to review your condition before you are assessed again.
If you have advanced disease, oxygen may be prescribed by your palliative care team. This may be for your use at home or in a hospice or nursing home. At this stage oxygen can relieve any distress that can occur when breathing is difficult.
If you need oxygen therapy:
- you will be given an explanation of what happens next and the choices you have
- you will be given information and training about using oxygen in a language you and your family or carers understand
- you will be shown the different types of equipment and encouraged to try them out to see which is best for you. Your prescription will be changed at a later date if you need a different oxygen therapy
- you might be asked if you need help with daily living from your local health care team or social services. If you do need help, someone will come to see you at home
- your GP will be told the result of your assessment and that you have been prescribed oxygen
- if you smoke, you will be offered support to help you quit