Why 88 to 92 Percent?

Time and time again I read or hear, “In individuals with COPD blood oxygen levels (sp02) should be kept between 88% and 92%.”  For individuals with COPD having an exacerbation or respiratory distress I am sure the medical profession has the research to prove it is right and do an excellent job of keeping us alive during exasperations.  But keeping all with COPD in that narrow sp02 range limits our ability to be active, takes away motivation, leads to a lower quality of life and often a downward spiral leading to another hospitalization and early death.  Time and time again I have read and heard health professionals from all walks say stay active for your health and improved quality of life.”  Help us stay active!  Don’t set up roadblocks by telling us to keep a sp02 of 88% to 92%.


A Sp02 of 88 to 92% Is Not For All?

“Anything between 92% and 88%, is still considered safe and average for someone with moderate to severe COPD.”

“For example, it isn’t uncommon for people with severe COPD to maintain their pulse ox levels between 88 to 92 percent.”

Above are two examples of many pages on the internet pushing a sp02 of 88 to 92% for all individuals with COPD.


“COPD and conditions associated with chronic respiratory failure.


In the treatment of exacerbations of chronic obstructive pulmonary disease (COPD), oxygen should be titrated to achieve a target oxygen saturation range of 88–92%.”


“Oxygen therapy and inpatient mortality in COPD exacerbation



Background In hospitalised patients with exacerbation of Chronic Obstructive Pulmonary Disease, European and British guidelines endorse oxygen target saturations of 88%–92%, with adjustment to 94%–98% if carbon dioxide levels are normal. We assessed the impact of admission oxygen saturation level and baseline carbon dioxide on inpatient mortality.”

“Oxygen therapy and inpatient mortality in COPD exacerbation


One-year mortality

Mortality at 1-year post discharge in those treated with supplemental oxygen In patients who received supplemental oxygen on admission and survived to discharge, the risk of death at 1year was 28%.  The 12-month mortality rates, excluding inpatient deaths, were: 87% or less=32%, 88%–92%=31%, 93%–96%=23%and 97%–100%=28% (including inpatient deaths these figures were 43%, 37%, 32% and 40%) (figure 3). The 93%–96%group had a significantly lower risk of death than the 88%–92%group,”


Both of the above are from the same study.  The 12-month mortality rate, excluding inpatient deaths for the 93%–96%group had a significantly lower risk of death than the 88%–92%group.    To me that means that many with COPD should have a goal for a saturation level of 88% to 96%.  Only those with certain risk factors should have target saturations of 88% to 92%!

I struggled with a sp02 of 88% to 92% at rest for over 5 years(much lower when active).  Three of those years were because the Inogen One G3 would not keep me above 91% even at rest and I was hesitant to turn my home concentrator much above my prescription of 2 LPM for any length of time.  When I picked a DME supplier that supplied me with a Respironics UltraFill I started a learning experience of what higher LPMs could do for me.  It wasn’t until I got a steady supply of liquid oxygen that my at rest sp02 moved into the low to mid-90s.  My blood pressure has dropped considerable!  The swelling in my lower legs is gone and I am much more active.

I am sure that if my first prescription had  prescribed liquid oxygen and told to use the LPM needed to keep me between a sp02 of 84% when exerting and 96% when at rest I would still be working.

Appropriate studies need done on not just on how to keep someone with COPD alive, but more importantly how to stay healthy with a higher quality of life.  Then educate those on supplemental oxygen and their caregivers.



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