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Why Oxygen Saturation Is NOT the Only Thing That Matters in COPD
I found this on facebook today and found it very helpful. It comes from a young physiotherapist by the name of Viyank Krnaval on the "COPD
Day to Day Living" group.
Why Oxygen Saturation Is NOT the Only Thing That Matters in COPD
I’ve noticed some confusion in the group about oxygen saturation (SpO₂), so I want to clear this up.
Many people focus only on the number on the pulse oximeter. While oxygen saturation is important, it is not the only indicator of how a COPD patient is doing.
I see this very often in clinical practice.
A patient can have normal oxygen levels (94–98%) and still feel extremely breathless. Why?
Because breathlessness in COPD depends on several factors:
1️⃣ Muscle strength
COPD patients often lose muscle mass due to inactivity or hospital stays. Weak muscles require more oxygen during activity, which increases breathlessness.
2️⃣ Lung mechanics
Air trapping and hyperinflation make it harder to move air in and out, even if oxygen saturation looks normal.
3️⃣ Endurance and conditioning
If you avoid activity because of breathlessness, the body becomes deconditioned. This creates a vicious cycle: less movement → weaker muscles → more breathlessness.
4️⃣ Breathing pattern
I frequently see patients breathing inefficiently (upper chest breathing, fast shallow breaths), which worsens symptoms even when oxygen is okay.
Another important point is oxygen targets in COPD.
For most COPD patients, the ideal oxygen saturation range is around 88–92%. Many people think oxygen should always be 100%, but that is not the goal in COPD patients who require supplemental oxygen.
If oxygen is given excessively and saturation is pushed too high (for example close to 100%), it can sometimes reduce the drive to breathe and also worsen CO₂ retention (hypercapnia).
That’s why we usually titrate oxygen carefully instead of trying to make the saturation 100%.
This is exactly why pulmonary rehabilitation is so important. It focuses not just on oxygen numbers but on improving breathing mechanics, endurance, and muscle strength so patients can function better in daily life.
I work with respiratory patients everyday and often see patients improve their walking ability and breathlessness even when their oxygen numbers stay the same.
So remember: don’t judge your lungs only by the pulse oximeter.
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With Medicare and insurers, you qualify for supplemental O2 when your O2 rate falls below 88% when you are resting, at activity or sleeping.
I use O2 for sleeping and activity and altitude (flying) to prevent damage to my heart, brain & other organs. You can ask to be referred to in person or virtual pulmonary rehab to help develop a safe and effective customized exercise program and learn more about breathing exercise, treatments, nutrition & so much more!
If there’s no program near you, Morlenhealth.com has a very good online program that accepts most insurers & medicare.
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3 ReactionsI, too, do not understand a lot of the test results that say I am moderate to severe. I am 67, walk 3 miles a day, do 8-10 Lb upper body weightlifting, have daily exercises I do as well. I weigh about 133 pounds. I am on BREO Ellipta 100/25 and take daily. I only take it because I would on occasion find myself short of breath, but nothing severe. I do not like the breathing test they give me I just find it hard to believe the results that show I am a severe in some test results, as if I should be on oxygen or something. What do you think?
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1 Reaction@benwa1950 never heard of it? Can the stretch esophagus or do what needed in that procedure?
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1 Reaction@snoots
You can research right on this site.
Or, call your insurance company to see if they cover it.
Actually cheaper than the old fashioned way.
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1 ReactionI’ve been diagnosed with moderate COPD and the biggest deterrent to health for me is too much activity in one day or weekend. I’m down for a day or two after I go visiting or out to lunch and clean part of house or cook in a day..is this normal?
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3 Reactions@jenben59
I am not sure...trying to figure it out myself. It sounds likecyou are doing pretty well. Here in Australia we have the Lung Foundation and they have Respiratory Nurses who will call you on the phone and I have learned a lot from them. They help with pursed lips breathing and box breathing techniques for when short of breath and advise try not to catch anything else. I think the hypertonic saline nebbing I do daily has helped me avoid further infections.
@benwa1950 I looked and saw you swallow a capsule with a camera in it takes about 12 hours. I have already gas a barium swallow and modified barium so I don’t need a camera procedure. They are going to do the endoscopic looking for the reason my food slows down at a certain point. If my esophagus needs stretching or anything they will do that. The acid reflux and suck at this point. Just keep loosing weight. Playfully they will get it moved to Apr and not July. Thanks though
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1 ReactionI do pierced lip breathing, finished rehab in January. My o2 is at 98/100 until I get on walking pad and it drops, breath it will come back up. But all this water to drink to thin mucus and dip water after every bit of good, it’s like it causing me to loose weight.
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1 Reaction@snoots
Best wishes and prayers for you to get what helps you to feel better.
Al Benoit.
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1 ReactionI described this situation to my new PT person where I'm seeing him to try to get less wobbly and stronger. He prescribes way more reps and sets per day then I can physically do without subsequent discomfort and I told him that in spite of my high oxygen levels, my actual lung capacity is at 50%. That means I have to rest more often and it takes longer to do everything, etc etc. Thanks for bringing this to everyone's attention; it doesn't seem to be common knowledge even amongst good health care providers.
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