The Ryan Report
Home Oxygen Guru – The HO2G Pen
Ryan Diesem
Ryan Diesem is Research Manager at Valley Inspired Products, Apple Valley, MN. Contact Ryan at [email protected] com with questions or comments.
Innovation in Home Oxygen Systems – Where Is It?
In the upcoming May/June issue of The Pulmonary Paper, we’ll be publishing our guide to portable oxygen concentrators (POCs), which has become an annual feature and one of the more anticipated articles of the year. More and more people are looking for guidance in purchasing home oxygen equipment that will fit their lifestyle while meeting their oxygenation needs. In beginning to prepare for the upcoming issue, I took an assessment of what products will be included this year and realized there hasn’t been much new in the last few years, let alone any product that could be qualified as innovative or bringing something new to the table. Numerous POCs were introduced between 2005 and 2013, but in the last five years, new products have trickled out, and none have really introduced any new features or capabilities that their predecessors didn’t carry as well. Many of the more recent POCs have been upgrades of existing models or products that were largely derived from the current product lines. If we expand our view to include other oxygen products like liquid oxygen systems and conserving regulators used on oxygen tanks, you realize there have been very few new products introduced after POCs entered the market. There clearly has been little push on the manufacturing side to release products capable of performing outside the established norms and expectations of home oxygen delivery systems.
There are some valid reasons for this lack of innovation that should not be discounted, primarily the changing economics in home oxygen reimbursement that have occurred over the last ten years. Liquid oxygen systems – still the lightest, longest-lasting option for portable use – have largely been phased out by home oxygen providers due to the cost of preparing, transporting, and deliver- ing the liquid contents to their users. Oxygen users with high flow needs (greater than 3 LPM) have been particularly bitten by this change as the other options made available to them either are too cumbersome (numerous tanks and regulators) or simply can’t meet their current oxygenation needs (POCs), especially when trying to be active. These are limitations that certainly can impact lower flow oxygen users on any type of system as well, but for many higher flow users, of what has been available, liquid oxygen was (and still is) an ideal system for portable use. With economics driving home oxygen decision making, any focus on providing products that come at a premium cost will certainly not be offered to the oxygen user since they will not be covered by insurances. Despite the clinical benefits new products could provide to oxygen users, the negative impact on the home care company’s bottom line prevents these from becoming a reality.
Other factors as to why we haven’t seen macatunruefrs innovate as much may include:
• The rise of the POC. Between 2002 and 2013, more than 25 models of POCs were introduced, the majority occurring after 2007. Manufacturers saw a hot commod- ity and jumped on the train, getting out a unit (or units) as quickly as they could. This meant focusing on making current technology work as quickly as possible, rather than exploring and/or expanding other ideas.
- The limitations of oxygen separation All concentrators work by pulling in room air, removing the nitrogen gas, leaving the remaining oxygen to the user. This technology has been around for over 40 years now, but the methods behind the process have not changed much. In many ways you can look at oxygen separation technology as trying to squeeze as much juice as efficiently as
possible from a lime – at some point, no matter how efficiently you do it, you just can’t get any more juice from that lime, so you have to add more limes if you want more juice. In terms of POCs, this means having to add size and weight to the machine to accommodate the need for more materials to improve oxygen pro- duction. Manufacturers looking to devel- op higher flow POCs in a small enough design to be considered portable may have simply hit a technological dead end.
- Lack of lung disease awareness and understanding. Lung disease is the third leading cause of death in the United States, but it often does not get the public attention that other diseases receive – including from manufacturers, generous investors and supportive benefactors will- ing to promote advancements in lung disease treatments. Part of this may be due to a less-than-glamorous association with smoking that lung disease can carry, despite there being a multitude of other reasons – cystic fibrosis, alpha-1 antitryp- sin deficiency, workplace contamination, – that someone might have lung dysfunction and require oxygen or other drug therapies. Public attention means awareness, and awareness means a gen- eral population understanding the condi- tions, needs and benefits of lung-healthy treatments for those with lung disease. Without the attention and support of a larger community, development and innovation will happen at a slower pace and be limited by the resources currently available
There is an obvious need for oxygen sys- tems that are better than what is on the market today. With the current economics of home oxygen, availability of liquid systems is going to be limited, leaving old fashioned cylinders with regulators and POCs as the primary portable options for oxygen users. Since cylinders are large, bulky and not very efficient when it comes to storage capacity (meaning they run out quickly when used, especially smaller-sized cylinders), POCs will likely remain the main focus of manufactur- ers’ oxygen product development going forward. That said, the SeQual Eclipse POC was introduced in 2005, when only a handful of POC options were available. The Eclipse was the POC with the highest production capacity – it has an output of 3 LPM con- tinuous flow – and highest number of user features. It is now 2018, numerous POCs have since been made available, and that descrip- tion from 2005 still largely applies. Further, in the 1980s, the late Dr. Thomas Petty (known as the “father of home oxygen”) stated that the ideal portable oxygen concentrator was one that weighed less than 10 pounds, could deliver 2 LPM of continuous flow, and have a single battery or operating life away from home for a minimum of four hours. In 2018 there are only two devices that come close to that description, but neither of them can deliver 2 LPM continuous flow for four hours on a single battery charge.
There is still a need for an improved delivery system beyond what is currently available, especially for those with higher oxygen needs. If we can’t have liquid oxygen systems as an option because no one will pay for and cover them, this system is going to have to improve on currently available POCs so that more users can benefit from their use. Is a 5 LPM continuous flow capable concentrator with robust pulse delivery settings and suffi- cient battery life that much of a pipe dream? I don’t think so. Would it be larger than ideal in size due to technological limitations? Probably. Would it have its own set of op- erating limitations? Definitely; every system does. Is it a difficult proposition to tackle? You bet. Would oxygen users be interested in a system like this? If the questions and feedback we regularly receive at The Pulmo- nary Paper are any indication, the answer is a resounding ‘Yes!’. My hope is that in the 2019 or 2020 May/June issue of The Pulmonary Paper that we have such a device listed in our guide. Here’s to hoping.