Technological innovation has always brought us ever-smaller and more efficient products, whether they be computers and cell phones or implantable medical devices and blood sugar monitors for diabetes. It should be of little surprise to anyone, then, that the near-2 million oxygen patients in the United States. are continually demanding smaller oxygen devices that approach the performance delivered by the powerful-but-heavy stationary concentrators. Technologically and medically, this demand will best be met by industry investment in shrinking battery-operated devices that have the power of the larger stationary machines, the size of portable concentrators, and, most important, the capability to meet a patient’s therapeutic needs.
Aging-but-active Baby Boomers will soon be the industry’s number-one market. And although they may be getting on in years, they still feel active and don’t want to be restricted to the confines of their homes. Years ago, long-term oxygen therapy (LTOT) was prescribed only to patients toward the end of their lives, when the need for mobility was not really an issue. Today, LTOT is prescribed much earlier, as more patients are diagnosed with earlier-stage COPD or other respiratory conditions. In these cases, a stationary concentrator is fine for the home, but patients need something that they can trust when they are out and about. Something they can use while visiting grandkids, taking camping trips, or flying overseas.
Sacrificing Solutions for Size
Before we get into describing the pros and cons of available oxygen systems and why battery-operated one-source devices represent the future, it should be noted that smaller only means better if efficiency and therapeutic requirements are met. Many oxygen device manufacturers today are fixated on demonstrating that their device is the sleekest unit available. They produce slick high-gloss marketing materials, yet their products do not adequately fulfill the needs of many oxygen patients. In fact, the amount of oxygen being delivered to the patient by some of these units is barely enough to be classified as supplemental oxygen.
Thus, the first question that manufacturers, providers, and patients should ask about any machine is “Is this providing effective oxygen therapy for the patient?” If the answer is no, they should go back to square one and find something that does.
Patients usually prefer the oxygen system that is the most convenient and comfortable and offers the best quality of life. Smaller oxygen systems may often succeed at filling the first two criteria, but it is incumbent upon the industry to ensure that therapeutic qualities are not sacrificed as manufacturers shrink their products.
The industry has tried to “portabilize” their devices in several ways, some more successfully than others.
For years, the primary option for active oxygen users has been portable refillable oxygen cylinders.
With these systems, a trip to the physician’s office is certainly doable. A day spent shopping and visiting friends could mean extra tanks as the hours add up. An overnight stay for a family reunion probably requires additional tanks plus arranging for a home stationary concentrator to make the trip—a daunting task given the size, weight, and shipping costs of stationary devices. A vacation requiring a plane ticket? This requires thorough advanced planning for airline-provided oxygen tanks to meet the patient for each leg of the flight, causing users countless headaches and sometimes costing thousands of dollars in extra fees.
Today, oxygen cylinder manufacturers have indeed developed small units that offer continuous oxygen flow. But these units still can run out of oxygen, meaning that replacement oxygen cylinders are required. Thus, portable oxygen cylinder-based units do not assuage the number-one fear of today’s oxygen patient: running out of oxygen.
Moreover, cylinder-based systems can require the oxygen provider to make weekly trips to a patient’s home to refill or exchange tanks. And although there are transfilling options that allow oxygen users to handle the cylinder-refilling process themselves (Invacare’s HomeFill II comes to mind), such options require accompanying compressors that weigh anywhere from 33 to 66 pounds, making the freedom to travel a moot point.
Accordingly, refillable tanks are not exactly the cure-all for today’s active oxygen patients who are not ready to give up on summer cruises or overnight trips to visit their grandkids.
Battery-Operated Portable Oxygen Concentrators
In response, battery-operated portable oxygen concentrators (POCs) that don’t need to be refilled hit the market a few years ago, giving active oxygen users peace of mind when venturing from home.
The classic POC works well for car trips where the unit can be plugged into the car’s power adapter; trips to establishments with easy access to power, such as restaurants, physician’s offices, and family members’ homes; as well as day trips independent of electrical outlets that can be completed within several hours and inside the machine’s battery life.
Battery-operated POCs from Inogen, Respironics, and AirSep have provided their users mobility to travel without having to lug oxygen cylinders along the way. The Inogen One weighs in at near 10 pounds and is about 12 inches high (with handle) and 6 inches wide. Respironics’ EverGo machine weighs 10 pounds and stands approximately 8 inches high and 6 inches wide. At 4.4 pounds, the FreeStyle by AirSep is nearly 9 inches high and 6 inches wide. These POCs are relatively small and lightweight, and allow users to travel without the worry of running out of oxygen—as long as an electrical outlet is near, the units can be recharged.
But as portable and worry-free as they are, these POCs still have a significant drawback: Their portability is made possible by limiting the amount of oxygen given to the user in each breath. These devices supply oxygen as users inhale, but save the oxygen when the user breathes out. The amount of oxygen they can generate is limited and often insufficient for more demanding situations such as exercise and high altitudes.
It is easiest for these POCs to synchronize oxygen delivery with breathing when patients are awake and relaxed. But what about when they are engaged in more unpredictable breathing patterns, such as those that occur when talking or during high activity or sleep? Many providers and respiratory therapists, recognizing that these units require a certain degree of breathing to trigger the oxygen output, do not recommend these conserving devices as a one-source oxygen machine. Why? Because when patients sleep, they cannot match their breathing with these machines. This can lead to oxygen desaturation, which can be both dangerous and counterproductive to the oxygen therapy process.
With POCs, many patients require two oxygen machines: one stationary for use during sleep and one portable for use during travel. Thus, even cutting-edge portable oxygen concentrators are limiting—users are often advised against making overnight trips and must be very careful while engaged in strenuous activity. Again, these are increasingly unacceptable conditions to a generation of oxygen users who will not be held back by technology.
From a medical device provider’s perspective, two oxygen machines per patient require more moving parts, more device training, more maintenance, and, often, more expense than a one-source device.
One-Source Oxygen Device
The challenge then, is finding a battery-operated device small enough to leave the home but powerful enough to let patients travel and sleep aboard an airplane or in a hotel. With its continuous flow and conserving flow capabilities, SeQual’s Eclipse Oxygen System is, for the time being, alone in this category, although competitors are almost certain to join it in coming years.
The Eclipse is heavier, at 18 pounds. But it comes with a set of wheels to increase portability, and it is powerful enough to provide 3 LPM of continuous flow—enough to satisfy the therapeutic needs of most oxygen patients.
It seems clear that the industry will benefit most by moving toward one-source solutions like the Eclipse that save the provider in long-term costs and afford patients immediate convenience and health advantages. SeQual and competing manufacturers are working on smaller one-source devices (fulfilling requirements for rest, active, and sleep modes) that will beat the Eclipse in size, and so we can expect continuing advances.
This competition is good for the industry and can only result in more and better options for patients and respiratory health specialists. Think of an oxygen patient at an all-day wedding—worry-free because her device won’t run out of oxygen. Picture a Baby Boomer from Denver taking a road trip to see his sister in Florida, using his one-source unit in the car and in hotels all along the way.
When it comes to oxygen systems, smaller can certainly be better, but it must be therapeutically effective, too. Across the country, people are replacing their landline home phones with cell phones. It will be a true success for the respiratory industry when the same can be said for refillable/stationary oxygen system packs and one-source battery-operated devices.
Vernon R. Pertelle, MBA, RRT, CCM, is vice president of outpatient services for the Tri-City Hospital District. North San Diego County, Calif, and sits on the board of directors of SeQual Technologies, San Diego. For further information, contact [email protected].