What If You Need 4 Liters of Oxygen — Or More?

Many people in this community require supplemental oxygen. Some use a nasal cannula set at 2 or 3 liters per minute (LPM), while others may occasionally — or eventually — require 4 LPM or more. Watching that flowmeter move higher can cause anxiety. If you are accustomed to using 2 or 3 LPM, moving up to 4 may make you wonder whether your COPD has suddenly become much worse.¹

That reaction is normal, but the number alone does not tell the whole story. So, let’s discuss why oxygen needs change, what to check before calling your doctor, when to seek help, and how a written oxygen plan can reduce your anxiety.

Why might your oxygen needs change?

So, say you check your oxygen saturation and notice it is below your target range, even though you’re using your prescribed oxygen setting. Your first thought may be to turn up the concentrator.

Before you do that, remember that oxygen is a medication. As a respiratory therapist, I encourage people to think of the number on the concentrator as part of their prescription. Unless your doctor has given you a plan explaining when and how to adjust it, you should not routinely turn it up yourself.

Breathlessness vs. low oxygen levels

There is another reason to be cautious. Feeling short of breath does not always mean your oxygen level is low. Tight airways, trapped mucus, an infection, heart problems, or even anxiety may make you feel breathless. More oxygen will not correct all those problems. Some people with COPD also retain carbon dioxide and need a very specific oxygen target.^2,3

Different oxygen settings for different activities

Your oxygen prescription may differ depending on what you’re doing. Some people need one setting while resting, another while walking or exercising, and a different setting while sleeping. Your needs may also increase during an infection or COPD flare-up.⁴

Quick troubleshooting checklist before calling your doctor

If you are not having severe symptoms, there are a few simple things you can check first. When I am called to a patient’s room because of a low oxygen saturation, I start at the wall and work my way toward the patient. It only takes a few seconds. You can do the same thing at home by starting at your concentrator and following the oxygen all the way to your nose, thinking about these checklist items:⁵

1. Is the concentrator running? Make sure it is turned on, set at your prescribed flow, and not displaying an alarm. If it is alarming, follow the instructions provided by your oxygen supplier.
2. Is the tubing connected? Follow it from the concentrator and make sure the tubing has not become disconnected, kinked, pinched, or trapped underneath furniture. In the hospital, this is one of the most common problems I find — and one of the easiest to fix.
3. Is the nasal cannula in your nose? Sometimes you become so accustomed to wearing it that you do not realize it has slipped out of place. It sounds obvious, but it is always worth checking.
4. Is the pulse oximeter reading accurate? Sit still, warm your hand, try a different finger, and give the number time to settle.

Knowing when to seek medical attention

If your saturation remains below your target after these checks, contact your healthcare provider before changing the flow. You should also call if your readings are gradually falling or you develop a fever, increased mucus, swelling, or morning headaches.^5,6

Call 911 for severe breathlessness at rest, chest pain, blue or gray lips, difficulty speaking, unusual sleepiness, or confusion. While waiting for help, follow your COPD action plan. Do not delay calling by repeatedly turning the concentrator higher.⁶

How a written oxygen plan can help reduce anxiety

One of the best ways to reduce anxiety is to ask your doctor to help you create a written oxygen plan. After all, nothing eases anxiety quite like knowing exactly what you are going to do.

Your plan should answer these questions:^4,6

• What oxygen setting should I use while resting, walking, and sleeping?
• What is my target oxygen saturation range?
• Am I allowed to adjust the flow myself? If so, how high can I turn it?
• If my oxygen remains below my target, how long should I wait before checking it again?
• When should I call my doctor, and when should I call 911?
• What is my backup plan if the power goes out or my concentrator stops working?

Keep a copy near your concentrator so you do not have to rely on your memory when you are short of breath or anxious. It also lets family members or caregivers know what to do if you need their help.

Moving up to 4 LPM or higher can cause anxiety. But having a written plan and knowing what to check can make the change easier to manage.

Follow your prescription, contact your doctor when readings stay low, and remember: the number on the flowmeter is only one part of your COPD story.

Taking control of your oxygen care

If you are feeling anxious about your current oxygen settings, consider bringing this article to your next appointment. Ask your healthcare provider to help you build a personalized, written oxygen plan so you can feel more confident and in control of your journey.