Ask Mark

Chris from EFFORTS asks if an oxygen saturation level below 94% will cause permanent damage to the body’s organs.

Mark replies: There is no evidence that a sustained saturation of 93% will significantly affect brain function or judgment. While at 88% things may start to get a little fuzzy for some, it is the “sustained” desaturation that is damaging to the brain and organs. We have many examples of people, whose oxygen saturation hovered in the low 80s and upper 70s for days during episodes of Adult Respiratory Distress Syndrome, who completely recovered with most,if not all their mental faculties intact. We can tolerate short-term drops in saturation without sustain- ing any significant injury. The “hard” number below which we see repro- ducible and frequent injury occur is “sustained” desaturation below 85%. Sustained means for a period of days and without significant rise in saturation during that time.

Comfort and performance of physical activities is another matter altogether. They do indeed suffer when saturation drops below 95% and more so, the lower it goes.

Kelly also wondered about permanent lung damage if you have an exacerbation.

Mark writes: Exacerbations are “flare-ups” of your COPD symptoms and can be caused by anything from inflammation to infections with viruses and or bacteria. The length, severity and ‘process’ of a given exacerbation may range from no permanent changes to severe and permanent damage that pushes a person into the next level of disease severity. We cannot simply categorize expectations and say what changes will occur for certain.

The best we might say is that what you as an individual make of your situation and its obstacles determines how you will do over time. I will talk incessantly about keeping moving and exercise and working “within” your discomfort and breathlessness to eventually push it back to where it doesn’t have such a powerful effect on you. We cannot overemphasize enough the fact that it is all dependent upon what you can tolerate towards regaining and increasing strength and function and achieving the best state of health and stability that you can. If you expend too much energy fretting about every little change and trying to analyze and categorize every detail of your disease, you’ll likely miss the most important details that have bearing upon living with COPD! Your attitude is critical in that quest!”

Myra writes: I have COPD and am on transtracheal oxygen. I noticed I become short of breath while trying to do chores, as using a vacuum wand.

Mark replies: I would start by asking you to review your level of activity and see if much, if not most, of your difficulty stems from simply being ‘out of shape’? Getting up and moving – especially doing tasks that require upper body exertion – takes those muscles away from helping with breathing and results in rapid onset of windedness. We then tend to do less and stop sooner. Over time, we find we cannot do what we could only a short time ago and the spiral continues until we can hardly function at all.

Exercises to strengthen your upper body are in order, but you need both resistance exercises for strength- ening and aerobic exercises for endurance. Arm biking and weight training for your upper extremities is in order. Walking and/or leg biking is necessary for your legs as well as step and leg resistance training exercises.

The greatest challenge you have is to resist stopping or slowing down when you ‘achieve’ windedness. Most folks make the mistake of thinking they should not get winded and have to work hard to breathe. The goal of exercise is to challenge your breath- ing, to get winded and to continue to work ‘within’ that windedness to achieve and maintain control of anxiety, panic and breathlessness with rhythmic and pursed-lip breath- ing. Folks who cannot do this will progress only modestly and very slowly. So, push as hard as you can. Breathe as hard as you can. Best Wishes!

Mark Mangus RRT, BSRC, is a member of the Medical Board of EFFORTS (the online support group, Emphysema Foundation For Our Right To Survive, www.emphysema.net) who generously do- nates his time to answer members’ ques- tions.