According to the latest World Health Organization estimates (2004), currently 64 million people carry a diagnosis of COPD and 3 million people have died from the disease.1 COPD ranks as the third leading cause of death, notes the American Lung Association (ALA),2 although with appropriate medical intervention, the condition can be controlled.

Left untreated, respiratory illnesses may result in cyanosis, edema, and confusion, among other, more serious, adverse effects. The most widely prescribed treatment for low oxygen levels is therapy using an oxygen concentrator. This therapy might call to mind large, cumbersome, dangerous, expensive machines with miles of attached tubing that limit mobility and cause embarrassment. However, technological advances have resulted in oxygen concentrators that enable users to maintain their independence, while receiving life-giving therapy without depleting financial resources.

Multiple Models

According to Matt Miller, business manager for stationary concentrators at Invacare in Elyria, Ohio, today’s oxygen concentrators reflect a shift in thinking. “The most obvious difference in stationary concentrators is the size and weight. Like many other products that have evolved over the years, they keep getting smaller and lighter. Patients prefer a less conspicuous piece of equipment over the larger, bulkier models from the past,” he says. “Units today are also more energy efficient, requiring less power, thus reducing a patient’s electric bill.”

While styles have changed, the way in which oxygen concentrators work does not differ significantly from previous models, notes Miller. “They still function in much the same way, but the components themselves have shrunk and are more reliable, which reduces the amount of time and money spent on maintenance,” he says. “For instance, Invacare units with oxygen sensors now require an oxygen purity check every 3 years versus annually. This helps reduce the overall cost of ownership for the unit by allowing providers to allocate resources to more profitable parts of their business.”

Kathy O’Brien, marketing and public relations manager for AirSep Corp in Buffalo, NY, agrees that today’s market offers a good selection of low-to-no-maintenance brands. “This is of huge benefit to providers who need to reduce operating costs and, certainly, to in-home patients, many of whom live alone or remotely and are generally not in a position to maintain their own concentrators anyway,” she says.

New and Improved

But even with significant advances, medical device companies continually try to improve on oxygen delivery systems. AirSep has created the NewLife oxygen concentrator, which incorporates contemporary styling, and the compact, lightweight, economical design of the AirSep VisionAire oxygen concentrator, according to O’Brien. “At just 30 pounds, this 5 LPM unit is also the quietest in its category at just 40 dBA, and offers great power savings with an energy consumption of only 290 watts. A 3 LPM model of this unit enables power consumption below 200 watts, ” she says. “In addition to an optional oxygen monitor, VisionAire can be equipped with an Air Outlet valve for enabling medication treatments directly from this oxygen concentrator. No maintenance requirements serve patients’ and providers’ needs especially well.”

AirSep also features a line of NewLife Intensity stationary concentrators that provide high pressure and high flow—up to 10 LPM at 20 psig—for special oxygen applications, such as operating jet nebulizers or administering treatments to tracheostomy patients. O’Brien says, “Both AirSep’s Intensity 10 LPM and its 8 LPM version of NewLife Intensity can be equipped with dual flowmeters to serve two patients simultaneously, which is ideal for the clinical care setting, or even economical for home use when there are two family members needing to utilize oxygen.”

Manufacturers understand the importance of creating portable devices that allow patients to maintain an independent lifestyle. “AirSep’s FreeStyle is only 4.5 pounds and has had overwhelming success among ambulatory oxygen patients. Now AirSep is launching the newest in its line of POCs [portable oxygen concentrators] with a unit even more reduced in size and weight than its current lightweight offering,” O’Brien continues. “At barely 1.75 pounds, this 2 LPM POC is for the patient whose concentrator [has] maximum mobility. For providers, it [represents] maximum mobility at minimum cost. AirSep FreeStyle 5, a greater capacity POC, will also enter the market in the near future for patients who need greater pulse flow capacity when ambulating.”

Other treatment options include the EverGo Portable Concentrator and EverFlo Concentrator by Philips Respironics, the Eclipse 3™ with autoSAT® by Caire SeQual, and the Inogen One POC.

The goal of these lightweight, affordable oxygen systems, according to O’Brien, is to provide maximum mobility for the patient, while still meeting clinical objectives. “Every direct contact with patients/caregivers and patient groups reinforces that objective. Patient compliance is much greater and can be even more so when patients become exposed and given access to lightweight systems that are not burdensome to carry and their worries about running out of oxygen contents are alleviated,” she says.

For some community-dwelling patients, a dual oxygen delivery system might be more appropriate. A compact stationary concentrator for daily in-home use, paired with a lightweight POC for patient use outside the home, offers flexibility and independence, while still delivering much-needed oxygen. “This alternative is a big economic plus for providers whose reimbursement costs associated with home deliveries and gas or liquid oxygen refilling are not keeping up with their costs,” says O’Brien.

Safety First

For patients who utilize more than one device for the treatment of COPD, overlap syndrome, or other respiratory illnesses—particularly simultaneous home oxygen therapy together with noninvasive ventilation (NIV) during the nighttime hours—some caution is recommended. Lobato and colleagues in Madrid conducted a study3 in which they tested the ability of the portable concentrator to deliver oxygen during the patient’s inhalation. Their findings indicate that the POC was unable to detect the patient’s inspiratory effort and deliver the preset oxygen flow throughout the different stages of the ventilator circuit: at the beginning, close to the ventilator, at the end, near the exhalatory valve, and at the nasal mask port. They determined that noninvasive ventilation could negatively affect trigger sensitivity in POCs, but they will continue to research the matter.

Expanding Markets

While hospitals, long-term care facilities, and nursing homes present as the most obvious consumers of oxygen products, the home care market is rapidly expanding. “Patients are being released from hospitals sooner. Home care is the only trifecta in the health care system because it is patient preferred, has better clinical outcomes, and is more cost-effective than institutional care,” Miller says, noting that home care technology has become more sophisticated, enabling any home to be transformed into a virtual hospital and/or nursing home.

O’Brien points out that regions where transportation costs are already high or on the rise present the biggest targeted growth areas for concentrator sales, since this oxygen delivery modality is the most economic. “Also, more and more focus is being provided clinically to aid in awareness and earlier detection in identifying oxygen patients and providing therapeutic intervention long before an end-stage diagnosis,” she says. “This results in a larger number of patients who are being successfully treated with oxygen, and often early enough so that a concentrator, particularly a POC, that can enhance opportunities for mobility for exercise, travel, and other out-of-the-home activities translates to greater quality of life and longevity for supplemental oxygen users.”

Taking Flight

New and improved POC models enable patients to plug their units into a vehicle’s DC outlet and head for the highway. The versatility of current oxygen concentrators also enables patients to cruise in their boats and take to the campgrounds in their RVs. For the last 6 years, air travel has become another possibility for those who require oxygen therapy. On July 12, 2005, the Federal Aviation Administration (FAA) approved the use of portable oxygen concentrators on commercial airlines. O’Brien notes that AirSep, the first company to develop a POC, the LifeStyle, is also the first to earn approval from the FAA for in-flight use. Several airlines permit the onboard use of POCs.4

In spite of the FAA’s ruling on POC use on board airlines now, some experts advise taking some precautions to ensure appropriate oxygen levels are delivered to the patient. A group of researchers from the department of pulmonary medicine at Oslo University Hospital conducted a randomized crossover trial5 in which 16 patients with COPD were exposed to alveolar hypoxia in three different settings: in a hyperbaric chamber, at 8,000 feet, and with a hypoxia-altitude simulation test (HAST). During the tests, patients received supplemental oxygen either by nasal cannula with continuous flow, via an oxygen-conserving device, and with a portable oxygen concentrator. Findings indicated that the HAST may identify patients who need supplemental oxygen during air travel. However, oxygen accumulates inside the facemask, which may cause an underestimation of the oxygen dose necessary when titration is conducted using a nasal cannula during a HAST. Further study is necessary.

Trends

Miller predicts that, in time, differences between stationary and portable oxygen concentrators will become almost invisible. “Reductions in size and weight of stationary concentrators are going to blur the line between stationary and portable units. The portable segment, such as the Invacare XPO2 portable concentrator and the Invacare Solo2 portable concentrator, is still in its infancy. Advancements in technology will make smaller and lighter designs possible. We may also see features in the future for patient monitoring and sharing data with clinicians due to Accountable Care Organizations (ACOs),” he says, adding that proactive patients may become catalysts for innovative changes to equipment. “With information much more readily available than in the past, patients are much more involved in the selection of their equipment. They are demanding products like portable concentrators that allow them to maintain their lifestyle. Patients are also more involved in their treatment, with many using pulse oximetry to self-monitor their conditions.”

With businesses carefully watching the bottom line, manufacturers of oxygen concentrators continue to seek ways to incorporate state-of-the-art technology into their products, simultaneously keeping customer costs within health care providers’ budgets. “This is a question that we think about quite often. The challenge is that technology does come at a cost,” says Invacare’s Miller. “The cost of raw materials has remained high as well. With recent reductions in reimbursement, and more likely to come, providers expect equipment to cost less. We are continuously looking at ways to be more efficient, streamline our supply chain, and design technology that will reduce our costs, so we can extend that savings to our customers.”

Phyllis Hanlon is a contributing writer for RT. For further information, contact [email protected].

References
  1. Chronic obstructive pulmonary disease (COPD). Available at : www.who.int/respiratory/copd/en. Accessed October 3, 2011.
  2. COPD. Available at: www.lungusa.org/lung-disease/COPD. Accessed September 28, 2011.
  3. Lobato SD, Rodriguez EP, Mayoralas S. Portable pulse dose oxygen concentrators should not be used with noninvasive ventilation. Respir Care. 2011 Jun 17. [Epub ahead of print]
  4. Portable Oxygen Concentrators – Airline Travel Chart. Available at: www.oximedical.com/content.cfm?id=2020. Accessed September 28, 2011.
  5. Akerø A, Edvardsen A, Christensen CC, Owe JO, Ryg M, Skjønsberg OH. COPD and air travel: oxygen equipment and preflight titration of supplemental oxygen. Chest. 2011;140:84-90.