Home Oxygen During Recovery From Pneumonia or Severe Infection

Why oxygen is needed after pneumonia

Pneumonia inflames the air sacs, which fill with fluid and debris and cannot transfer oxygen well. Even after treatment clears the infection, the lungs can take weeks to months to recover fully. In older adults, especially those with heart or lung disease, the recovery is slower. Some people also have lingering low oxygen levels on exertion even if they are fine at rest. Home oxygen is prescribed when tests show that the oxygen level is persistently low. See pneumonia in older adults: prevention and recovery.

For COVID-19 and similar infections, some people recover quickly, others have lingering breathlessness and low exertional oxygen for weeks. The same principle applies: oxygen is a prescribed medicine used for a defined period.

The prescription

On discharge, ask for a written prescription that states:

• Flow rate in litres per minute, and the delivery device (cannula or mask).
• When to use it: at rest, with activity, during sleep, or continuously.
• Target oxygen level range on the oximeter.
• How long until review, and who will review it.
• Warning signs and whom to call.

See oxygen flow rates and prescriptions: what families should know. Do not alter the flow or the hours yourself. If your parent seems more breathless, call the doctor; if severely breathless, call 112.

Equipment and set-up

Most families use a concentrator for steady daily use and a cylinder as backup; some use a rented portable unit. Read oxygen concentrators: a buying and renting guide, oxygen cylinder or concentrator: which suits home use? and renting breathing equipment: costs, checks and return. For a temporary need, renting often makes sense. Arrange delivery and a demonstration before discharge, so that the equipment is in place when your parent arrives home. Prepare a room with a bed or chair that allows upright sitting, a clear path for the tubing and a socket suitable for the concentrator; see hospital room at home: complete setup.

Safety essentials

• No smoking and no flames near oxygen: no diyas, candles, incense, gas stoves or matches in the room.
• No oil, grease or petroleum jelly on the face or on the equipment.
• Backup supply in case of power cut or machine failure; see oxygen at home and power cuts: a backup plan.
• Tubing safety to avoid trips; see falls risk assessment at home.
• Equipment care: see using an oxygen concentrator safely at home and oxygen cylinder safety at home.

Using the oximeter during recovery

A fingertip oximeter is commonly used by families recovering from pneumonia or COVID-19, as advised by the doctor. Use it consistently:

1. Rest for five minutes, sitting upright. 2. Warm the hand, remove nail polish, and place the clip on a middle or index finger. 3. Keep the hand still at heart level. 4. Wait until the number is steady. 5. Record the highest stable reading, the pulse and how your parent feels, with the date and time. 6. Check at the times the doctor advised, for example morning and evening, and with activity if asked. Avoid checking every few minutes, which increases anxiety.

Remember that oximeters can mislead: cold fingers, movement, polish and some skin tones can give wrong readings, and a normal reading does not exclude trouble. See pulse oximeters: how they work and how to use one and pulse oximeter accuracy. Treat symptoms seriously whatever the number. See when oxygen saturation is low: what to do.

Ask the doctor what numbers should prompt a call. Common instructions are to call the same day if the reading at the prescribed flow falls below the target range or is clearly lower than your parent's usual, and to call 112 for very low readings with distress.

How oxygen is reduced and stopped

Doctors reduce oxygen step by step, based on measurements. They may:

• Check oxygen at rest and during a walk, at a clinic visit or by a home nurse.
• Reduce the flow or the hours of use if levels stay in the target range without it.
• Test off oxygen for a short period while measuring, in a supervised way.
• Repeat checks after several days or weeks.
• Stop oxygen once levels stay safe at rest, with activity and during sleep, as judged by the doctor.

Do not switch off oxygen because your parent feels better, or because the oximeter looks good. Feeling well and having safe oxygen levels are not the same. Likewise do not continue oxygen indefinitely without review, because it can become a crutch for no reason. Ask: "When is our next oxygen review?" and write the date down.

Recovery: what to expect

• Tiredness and breathlessness that improve gradually over weeks to months.
• Cough that may linger for several weeks.
• Loss of weight and muscle, needing good nutrition and strengthening; see loss of appetite in older adults and how much protein do seniors need.
• Low mood, anxiety and sleep problems, common after serious illness; see anxiety in older adults.
• Memory or concentration issues, sometimes called brain fog, in some people after severe illness.
• Risk of falls from weakness and tubing; see what to do after a fall.

Rebuilding strength safely

When the doctor agrees, begin gentle breathing and activity:

• Breathing techniques and positions; see breathlessness: positions and breathing techniques that help.
• Short, frequent walks with rests, increasing gradually. If your parent uses oxygen, take the oxygen on walks as prescribed.
• Chair-based exercises and arm and leg strengthening; see pulmonary rehabilitation exercises at home and chair exercises for seniors.
• Pacing and rest.
• Sitting out of bed during the day, to help the lungs expand.
• Stop and rest for severe breathlessness, dizziness, chest pain or palpitations.

Nutrition and fluids

Aim for small, frequent, protein-rich meals and enough fluids, unless the doctor has restricted fluids for heart or kidney disease. Dietician help can tailor Indian meals to taste and budget. See malnutrition in older adults and hydration for older adults.

Preventing another infection

• Vaccines: after recovery, ask the doctor about influenza, pneumococcal and COVID-19 vaccines; see vaccines that protect older lungs.
• Hand hygiene for everyone, and avoiding contact with people who are unwell; see infection control for home caregivers.
• Good air at home, with no smoke; see indoor air quality for older lungs: dust, smoke and damp.
• Dental and mouth care, which lowers the risk of inhaling germs.
• Safe swallowing: tell the doctor about coughing during meals; see swallowing problems (dysphagia) in older adults.
• Follow-up: attend review visits. Some doctors arrange a follow-up chest X-ray after pneumonia, particularly for older people or smokers, to confirm that the lungs have cleared; follow your doctor's plan.

Warning signs

Call the doctor the same day if:

• Breathlessness is increasing, or your parent cannot do what they could a few days ago.
• The oximeter readings at the prescribed flow are below target or falling.
• A fever returns, cough worsens or sputum changes.
• Swelling, rapid weight gain or new tiredness appear.
• Appetite or drinking falls.

Call 112 if:

• Your parent is struggling to breathe or cannot speak in sentences.
• Lips or fingertips are blue or grey.
• There is chest pain, a sudden sharp pain on breathing, coughing up blood or one leg swollen and painful (possible blood clot).
• Confusion, drowsiness or collapse occurs.
• The oxygen equipment fails and there is no backup.

When to ask a professional

Ask the doctor for the oxygen prescription, target range, review date and a written plan. Ask a nurse or physiotherapist to teach breathing and exercises. Ask the supplier for training and backup. Ask a dietician for meal plans. Call the doctor for any concerning change, and 112 for emergencies.