Starting Home Oxygen Therapy: A Complete Guide for Patients and Families in South Africa
- Matthew Hellyar
- Aug 3
- 15 min read
Being prescribed oxygen can change the atmosphere in a room.
A doctor may explain the medical reason clearly, yet the patient and family may still leave with dozens of unanswered questions.
Does this mean my condition is getting worse?
Will I need oxygen forever?
Can I still leave the house?
What happens if the electricity goes off?
Will I become dependent on the machine?
These are not small concerns. They affect how safe, confident and independent a person feels when beginning home oxygen therapy.
The first thing to understand is that oxygen is not a symbol of failure. It is a prescribed medical treatment intended to correct low oxygen levels and support the body when the lungs, heart or circulation cannot maintain enough oxygen on their own.
For some people, oxygen is needed only during recovery from an illness. Others use it while sleeping, walking or exercising. Some patients require long-term oxygen therapy for many hours each day. The correct plan is different for every person and should be based on medical testing, symptoms, the underlying condition and daily oxygen requirements.
This guide explains what patients and families need to know when starting home oxygen therapy: how the equipment works, why the prescription matters, how to prepare for power interruptions, how to remain active and how to use oxygen safely without allowing it to take over your life.
What is home oxygen therapy?
Home oxygen therapy provides air containing more oxygen than the air around us. The oxygen is delivered through a nasal cannula or mask connected to a concentrator, cylinder or another prescribed oxygen system.
It is usually prescribed when testing shows that the oxygen level in a person’s blood is too low. This is known as hypoxaemia.
A doctor may assess oxygen levels while the patient is resting, walking, exercising or sleeping because the body’s requirements can change under different conditions. A person may have an acceptable oxygen level while sitting but experience a significant drop while moving. Another patient may require oxygen mainly during sleep.
Oxygen may be prescribed for people living with conditions such as:
Chronic obstructive pulmonary disease, or COPD
Interstitial lung disease
Pulmonary fibrosis
Pulmonary hypertension
Certain heart conditions
Chronic respiratory failure
Recovery following a serious respiratory illness
Other conditions that cause low blood oxygen
The diagnosis alone does not decide whether someone needs oxygen. The decision should be based on an individual clinical assessment.
Oxygen should therefore never be started simply because somebody feels breathless, and it should not be purchased and used without medical guidance. Breathlessness can have many causes, and oxygen is not the correct treatment for every cause.
Your oxygen prescription is more than a flow-rate number
A home oxygen prescription may appear simple, but it can contain several important instructions.
These may include:
The oxygen flow or device setting
Whether oxygen should be delivered continuously or in pulses
How many hours it should be used each day
Whether it is required during rest
Whether it is required during sleep
Whether it is required during activity or exercise
The oxygen delivery device to be used
The type of cannula or mask
The target oxygen range set by the treating clinician
These instructions are not interchangeable.
A patient may, for example, be prescribed one setting while resting and another during activity. Another person may need continuous-flow oxygen at night but use a suitable portable system during the day.
Never increase, reduce or stop oxygen without speaking to the treating healthcare professional. More oxygen is not automatically better, and too little oxygen may fail to meet the body’s needs. Oxygen is a medical treatment and should be used at the prescribed rate for the prescribed situation.
Why you should not turn up the oxygen when you feel breathless
Breathlessness and low oxygen are related, but they are not the same thing.
A person may feel breathless because of an infection, airway narrowing, fluid retention, anxiety, pain, physical deconditioning, heart problems or progression of an underlying disease. Increasing the oxygen setting may not treat the cause.
New, severe or rapidly worsening breathlessness should not be managed by repeatedly turning up the machine. Follow the medical action plan provided by your healthcare team and seek professional help when symptoms change.
Understanding your home oxygen equipment
There is no single oxygen system that suits every patient. The right equipment depends on the prescription, the required oxygen delivery, the patient’s breathing pattern, how often oxygen is needed and what the patient needs to do during the day.
1. Stationary oxygen concentrators
A stationary oxygen concentrator draws in air from the room, removes much of the nitrogen and delivers concentrated oxygen through the patient’s tubing.
These machines are commonly used by patients who require oxygen for long periods at home or while sleeping. They run from household electricity and do not need to be refilled with oxygen in the same way as a cylinder.
A stationary concentrator may form the foundation of a patient’s home treatment, but it should not automatically be treated as the answer to every part of daily life. A person who needs oxygen when walking, attending appointments or leaving home may also need an appropriate portable solution.
2. Portable oxygen concentrators
Portable oxygen concentrators are smaller machines designed to provide supplemental oxygen away from home. They usually operate using rechargeable batteries and can often be powered from a wall outlet or compatible vehicle power supply.
Many portable concentrators deliver oxygen through pulse-dose technology. The machine senses the beginning of an inhalation and releases a measured amount of oxygen as the patient breathes in. Some larger portable models can provide continuous flow, but many do not.
A pulse setting is not the same as litres per minute of continuous flow.
A setting of “2” on a portable concentrator should not be assumed to equal two litres per minute from a stationary concentrator or cylinder. Settings may also differ between portable models.
This is why a portable concentrator must be matched to the prescription and, where appropriate, assessed while the patient is resting and moving. A small, attractive or inexpensive machine is not useful if it cannot safely meet the person’s oxygen needs.
3. Medical oxygen cylinders
A medical oxygen cylinder stores compressed oxygen and does not rely on electricity.
Depending on the prescription and service arrangement, cylinders may be used as a primary source, a portable option, a short-term solution or a backup for power interruptions and equipment problems.
Cylinders must be stored securely and handled correctly. They should be protected from falling, excessive heat and unsafe transport. Patients and families should know how to read the cylinder contents, operate the regulator and estimate when a replacement is required.
4. Nasal cannulas and masks
A nasal cannula is the light tubing with two small prongs that sit inside the nostrils. It allows many patients to speak, eat and move more easily than they might with a mask.
Some patients require a mask or another interface because of their oxygen needs or clinical situation.
Cannulas, masks and tubing should be fitted correctly and replaced according to the supplier’s or manufacturer’s instructions. Damaged, blocked, dirty or poorly connected tubing can interfere with treatment.
The first-day oxygen checklist
When the equipment arrives, the patient and at least one family member or caregiver should receive a complete demonstration.
Do not be afraid to ask the person completing the setup to repeat something. A delivery is not complete merely because the machine has reached the house.
Before the setup team leaves, you should understand:
Which device is the main oxygen source.
The exact prescribed setting.
When the oxygen must be used.
How to switch the equipment on and off.
What every alarm means.
How to check that oxygen is flowing.
How to connect the cannula or mask.
How to use the backup oxygen supply.
Whom to contact if the equipment fails.
What to do during a power interruption.
How to clean and maintain the equipment.
How to order replacement supplies.
How to prepare for appointments and trips.
When a change in symptoms requires medical attention.
A useful approach is “teach-back”: after the demonstration, the patient or family member performs the steps themselves while the support person watches. This reveals uncertainty before it becomes a problem at night or during an emergency.
Keep the prescription, equipment instructions and important telephone numbers together in an easy-to-find place.
Planning for power interruptions
A stationary oxygen concentrator requires electricity. Every household using one should therefore have a written backup plan.
That plan should answer four questions:
What will we use if the electricity goes off?
This may be a medical oxygen cylinder, a suitable battery-operated concentrator or another backup system approved for the patient’s requirements.
The backup must match the prescription. A portable pulse-dose machine may not be an appropriate substitute for a patient who requires continuous flow, a high oxygen output or a particular night-time setup.
How long will the backup last?
Know how long the cylinder or batteries are expected to last at the patient’s actual prescribed setting—not at the lowest advertised setting.
Check cylinder contents and battery charge regularly. Backup equipment that is empty, uncharged or inaccessible is not a backup.
Who will we call?
Keep the oxygen provider’s support details visible. Family members should know when to call the provider, the treating clinician or emergency medical services.
What happens during a long interruption?
Agree on a plan before it is needed. This may include additional cylinders, charged batteries, transport to a location with power or escalation to medical care, depending on the patient’s condition and prescription.
Never wait for the concentrator to switch off before beginning to think about the backup.
Oxygen safety at home
Oxygen itself does not ignite, but it causes other materials to burn faster and more intensely. This makes fire prevention one of the most important parts of home oxygen therapy.
No smoking or vaping near oxygen
Nobody should smoke or vape near the patient, the oxygen equipment or the room where oxygen is being used or stored.
This rule applies to the patient, visitors, caregivers and everyone else in the household.
Keep oxygen away from flames and heat
Keep oxygen equipment away from:
Candles
Gas stoves
Open fires
Heaters
Braais
Matches and lighters
Sparking equipment
Other ignition sources
Follow the safety distances supplied by the equipment provider or manufacturer.
Use skin and lip products carefully
Petroleum-based products may create an additional fire hazard around oxygen. Do not use petroleum jelly, oily creams or similar products close to the nose, cannula or mask unless the healthcare team has confirmed that a product is safe.
Ask about a suitable water-based moisturiser if oxygen is causing dryness.
Store equipment correctly
Do not store oxygen in a closed cupboard, car boot or poorly ventilated area. Secure cylinders upright or according to the supplier’s instructions, and do not leave oxygen equipment in a hot vehicle.
Protect the electrical supply
Plug the concentrator into an appropriate wall outlet and follow the manufacturer’s electrical instructions. Do not use an unsuitable extension lead, adaptor or overloaded plug.
Prevent trips and falls
Route tubing carefully along walls or around furniture. Avoid loose coils across walkways. Longer tubing may make movement easier, but only use tubing lengths approved for the equipment and prescription.
A safe oxygen home should support movement, not create a new fall risk.
Can I still leave the house?
For many patients, the answer is yes.
Needing oxygen should not automatically mean remaining in one room or giving up family visits, appointments, shopping, places of worship, meals out or time outdoors.
The correct portable oxygen solution can help suitable patients remain active and participate in daily life. Portable concentrators and smaller cylinder systems are designed for use away from the stationary home setup, but the device must meet the patient’s prescribed oxygen requirements.
Before leaving home:
Confirm that the device is working.
Check the battery or cylinder contents.
Carry enough oxygen for the outing and unexpected delays.
Take the charger or compatible power supply where appropriate.
Carry a spare cannula.
Keep emergency and provider contact details with you.
Secure the device during transport.
Avoid heat, flames, smoking and enclosed storage.
Start with manageable outings. A short visit or appointment can help a patient become familiar with the portable equipment before attempting a full day away from home.
Confidence usually develops through preparation and experience.
Portable oxygen provides freedom for all patient click here for more information
Exercise and oxygen therapy
Staying active is important for many people living with chronic lung disease, but exercise should be approached according to the patient’s clinical condition and medical plan.
Some people have acceptable oxygen levels while resting but experience a drop during walking or exercise. Their clinician may prescribe ambulatory oxygen for physical activity.
Oxygen does not replace rehabilitation, movement or muscle conditioning. It may make prescribed activity more manageable by helping correct low oxygen during exertion.
Pulmonary rehabilitation can also help patients learn how to exercise safely, pace
themselves and manage breathlessness.
Do not begin a demanding exercise programme simply because oxygen is available. Ask the treating healthcare professional:
Which activities are safe?
What oxygen setting should be used during activity?
What symptoms mean I should stop?
Should I attend pulmonary rehabilitation?
Should my oxygen level be assessed while walking?
The aim is not to push through danger. It is to preserve strength, function and confidence as safely as possible.
Sleeping with oxygen
Some patients are prescribed oxygen during sleep because their oxygen level falls at night. Others require oxygen throughout the day and night.
Use the exact night-time setup prescribed by the clinician. Do not assume that a daytime portable setting is suitable during sleep. Pulse-dose devices may behave differently depending on breathing pattern, and not every portable system is appropriate for every sleeping patient.
Arrange tubing so that it does not become tightly wrapped, kinked or trapped under furniture. Keep the equipment in a well-ventilated position and follow the supplier’s placement instructions.
Morning headaches, unusual sleepiness, confusion or a significant change in sleep quality should be discussed with the treating healthcare professional rather than managed by changing the oxygen setting independently.
Using a pulse oximeter responsibly
A pulse oximeter estimates the amount of oxygen carried in the blood. It can be useful when it forms part of a plan explained by a healthcare professional.
However, the number should not be interpreted in isolation.
Readings may be affected by movement, poor circulation, cold hands, nail polish, device quality and skin pigmentation. The United States Food and Drug Administration continues to warn that pulse oximeters have limitations and may be less accurate under certain conditions, including in people with darker skin pigmentation.
For a more reliable reading:
Sit still and rest your hand.
Make sure the hand is warm.
Remove nail polish if it interferes with the device.
Wait for the reading to settle.
Consider the trend, not one rapidly changing number.
Pay attention to symptoms as well as the reading.
Follow the target range given by the treating clinician.
Do not repeatedly increase oxygen based on a single home reading unless your medical plan specifically tells you to do so.
A patient who is severely breathless, confused, blue or grey around the lips, experiencing chest pain or struggling to speak requires urgent medical assessment, regardless of what the oximeter displays.
Managing dryness and discomfort
Oxygen can cause dryness inside the nose. Cannula tubing may also irritate the nostrils, cheeks or ears.
Do not silently tolerate significant discomfort. Small problems can eventually make a patient reluctant to use the oxygen as prescribed.
Speak to the oxygen provider or healthcare team about:
Correct cannula size and positioning
Soft ear protectors
Safe water-based nasal products
Whether approved humidification is appropriate
Replacement of stiff or damaged tubing
Skin irritation beneath the cannula or mask
Never add a humidifier or modify equipment without checking that it is compatible with the specific oxygen system and prescription.
Travelling with oxygen
Many people travel successfully while using oxygen, but travel requires planning.
Begin by speaking to the treating doctor and oxygen provider. Oxygen needs can change during flights and at higher altitudes, and the usual home system may not be suitable for the journey.
For air travel, contact the airline well in advance. Airlines determine which portable oxygen concentrators are accepted, how much battery capacity must be carried and what medical documentation is required. Compressed oxygen cylinders are generally not permitted for personal use in an aircraft cabin, while an approved portable oxygen concentrator may be allowed subject to the airline’s rules.
When travelling by car:
Secure the oxygen system.
Keep the vehicle ventilated.
Do not allow smoking.
Keep oxygen away from heat.
Never leave the equipment in a hot, closed vehicle.
Carry sufficient oxygen for delays.
The most important travel rule is simple: plan around the prescription, not around the best-case travel time.
When should I contact my oxygen provider?
Contact the oxygen provider when:
The machine displays an alarm you do not understand.
The concentrator does not appear to be producing oxygen.
Tubing, cannulas or connectors are damaged.
The equipment has fallen or been exposed to water.
Battery performance has changed significantly.
A cylinder is running low.
You are unsure how to use the backup system.
You are planning a trip and need equipment guidance.
You need replacement supplies.
The equipment no longer fits your routine or prescribed needs.
The oxygen provider can assist with equipment and service issues. Changes to the prescription, flow rate or clinical treatment must be discussed with the treating healthcare professional.
When should I seek medical help?
Contact the treating healthcare professional when:
Breathlessness is worsening.
The usual oxygen plan is no longer providing the expected relief.
Oxygen readings are repeatedly outside the target range provided by the clinician.
There is a new cough, fever or suspected infection.
The patient develops unusual morning headaches.
There is new drowsiness, confusion or weakness.
The patient cannot tolerate the prescribed equipment.
There is a significant change in exercise ability or daily function.
Seek urgent medical help for severe breathing difficulty, an inability to speak normally because of breathlessness, blue or grey lips or skin, chest pain, collapse, severe confusion or a reduced level of consciousness.
Do not delay emergency care while repeatedly checking a pulse oximeter or adjusting equipment.
Questions every patient should ask an oxygen provider
A home oxygen provider should do more than leave a machine at the door.
Ask:
Will you explain and demonstrate the equipment in my home?
Who can I contact if the equipment fails?
What backup oxygen is appropriate for my prescription?
How long will my backup supply last?
What should I do during a power interruption?
How are replacement cannulas and supplies provided?
How is the equipment maintained or serviced?
Can you support me with portable oxygen?
What should I do before travelling?
How will you work with my doctor if my prescription changes?
Will a family member or caregiver also receive training?
What support is available after the initial setup?
A patient should never feel embarrassed about asking these questions. Understanding the treatment is part of using it safely.
Choosing the right home oxygen provider
The oxygen device matters, but the service around the device matters too.
A suitable provider should be able to:
Interpret and fulfil the written oxygen order correctly
Supply equipment that matches the prescription
Deliver and set up the equipment
Teach the patient and family how to use it
Explain alarms and troubleshooting
Help establish a backup plan
Provide ongoing equipment support
Assist with portable oxygen options
Communicate clearly when the prescription needs medical review
Respocare’s oxygen service includes home oxygen therapy, portable oxygen systems, equipment setup, patient education and ongoing assistance. The aim is to make the transition from prescription to daily treatment clearer and less stressful for patients and families.
The provider should never independently replace the role of the doctor. The clinician determines the medical prescription. The provider’s responsibility is to supply, explain and support the prescribed equipment safely.
The emotional side of oxygen therapy
The practical concerns are only part of the adjustment.
Some patients feel self-conscious about wearing a nasal cannula. Others worry that people will see them as weak or seriously ill. Some become afraid to leave the house in case the battery runs out, the machine alarms or they become breathless in public.
These feelings deserve to be taken seriously.
Oxygen therapy changes routines, but it does not change the value, identity or dignity of the person using it.
A portable device may make an outing possible. A backup cylinder may restore confidence during the night. A well-explained plan may reduce the fear of equipment failure. A family member who understands the system can make the patient feel less alone.
Adjustment often happens gradually.
The first goal may not be a holiday or a long day away. It may be sitting outside, walking to the gate, visiting a family member or attending an appointment without fear.
Those steps matter.
Frequently asked questions
Can you become addicted to oxygen?
Prescribed oxygen does not create an addiction. A patient may continue to need it because the underlying medical condition still causes low oxygen—not because the oxygen itself created dependence.
Can I reduce my oxygen when I feel better?
Do not reduce or stop oxygen without medical guidance. Feeling better does not necessarily mean the blood oxygen level remains safe during sleep, activity or throughout the day.
Can I increase my oxygen when I feel breathless?
Only follow an adjustment plan specifically provided by your healthcare professional. New or worsening breathlessness may have a cause that requires medical assessment.
Can I use a portable concentrator instead of my home machine?
Sometimes, but not automatically. Portable devices differ in oxygen output and delivery mode. Many provide pulse-dose rather than continuous-flow oxygen. The portable device must meet the patient’s prescription.
What happens if the electricity goes off?
Switch to the approved backup system according to your written plan. Contact the oxygen provider if the interruption may outlast the available backup. Seek medical help if the patient is deteriorating.
Can I sleep with oxygen?
Yes, when oxygen has been prescribed during sleep. Use the exact device, interface and setting recommended by the treating clinician.
Can I exercise while using oxygen?
Many patients can remain active and may be prescribed oxygen during exertion. Ask the treating clinician or pulmonary rehabilitation team which activities and settings are appropriate.
Can I travel while using oxygen?
Many patients can travel with advance planning. Speak to the doctor, oxygen provider and transport operator or airline before the trip.
How often should I clean or replace the cannula?
Follow the instructions supplied by the oxygen provider and equipment manufacturer. Replace equipment sooner if it is damaged, dirty, stiff or no longer fitting correctly.
Oxygen should support your life—not become your whole life
Starting oxygen therapy can feel like losing control.
In reality, the right prescription, the right equipment and the right support can help restore it.
Control means knowing what the settings mean.
It means having a backup before the electricity goes off.
It means understanding the alarms.
It means being able to leave home with enough battery or cylinder capacity.
It means recognising when a problem belongs to the equipment provider and when a change in symptoms requires medical help.
Most importantly, it means remembering that the patient is not a machine setting, a diagnosis or an oxygen reading.
There is still a life to be lived around the treatment.
At Respocare, we believe that providing oxygen is not simply a matter of delivering equipment. It is a responsibility to educate, prepare and support the person who will depend on that equipment every day.
Because oxygen therapy should never leave a patient feeling abandoned at home.
It should help them breathe with greater confidence, move with greater freedom and continue participating in the moments that make life meaningful.
Speak to Respocare
Have you or a family member recently been prescribed home oxygen?
The Respocare team can assist with home oxygen concentrators, portable oxygen solutions, medical oxygen cylinders, equipment setup and patient support.
Speak to a real member of our team about your prescription, your home setup and the practical support you may need.
Medical disclaimer
This article provides general patient education and does not replace advice from a doctor, pulmonologist, respiratory specialist or other qualified healthcare professional. Oxygen is a prescribed medical treatment. Do not start, stop or change an oxygen flow rate or device setting without medical guidance. Seek urgent medical attention for severe or rapidly worsening symptoms.
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