Why Oxygen Saturation Is NOT the Only Thing That Matters in COPD

Posted by roberthoneywell @roberthoneywell, Mar 16 12:46pm

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.

Interested in more discussions like this? Go to the COPD: Chronic obstructive pulmonary disease Support Group.

mersterling | @mersterling | Jun 5 4:28pm

In reply to @mjb24 "@mersterling Oops, I must have forgotten to paste it. Here it is. https://www.respiratorytherapyzone.com/pulmonary-rehab-exercises/" + (show)

@mjb24 thanks! I'll definitely check it out.

Mary | @mjb24 | Jun 5 6:13pm

In reply to @mersterling "@mjb24 thanks! I'll definitely check it out." + (show)

@mersterling For the past 3 weeks I've been doing pursed Lip, deep breathing, box breathing, Segmental breathing and diaphragmatic breathing for 5 minutes each, twice a day and already notice an improvement. I've also been on my stationary bike 5 days a week. Not sure which one is helping or maybe a combination of all the above but I definitely can keep going longer and have more energy.

mersterling | @mersterling | Jun 6 6:11am

In reply to @mjb24 "@mersterling For the past 3 weeks I've been doing pursed Lip, deep breathing, box breathing, Segmental..." + (show)

@mjb24 how long do you ride the bike?
And, what is segmental breathing?

Mary | @mjb24 | Jun 6 11:00am

In reply to @mersterling "@mjb24 how long do you ride the bike? And, what is segmental breathing?" + (show)

@mersterling I started at 10 minutes a day, increased that to 12, then 15 and the last 2 days I've been able to do 20. I check that my heart rate doesn't go over 85% of my max. I check my oxygen also to make sure it doesn't drop too low. We are all different with varying effects from our illness so we have to adjust accordingly. But I think just doing something rather than nothing is helpful. Segmental breathing is supposed to help expand the lungs and improve gas exchange. Part of my left upper lobe is collapsed and I read that this breathing exercise may help to re-inflate the tissue. I have COPD, Cavitary MAC and now some bronchiectasis, so the collapse is probably due to the MAC infection. I had a PFT done recently and in 2 years my DLCO (diffusion capacity) decreased by 24% thus my search for how to improve lung function which lead me to the importance of both breathing exercises, cardio exercise and strength training. It's all worth trying and I can't get over how I just feel so good after exercising. Emphasis on after, during the exercises is another story but no pain, no gain, right?

mersterling | @mersterling | Jun 6 11:36am

In reply to @mjb24 "@mersterling I started at 10 minutes a day, increased that to 12, then 15 and the..." + (show)

@mjb24 Thank you; very helpful info. Wishing you the best and with great respect for your proactive and positive approach...

kdalda75 | @kndaustin71 | Jun 7 3:43pm

@roberthoneywell Excellent information! Thank you! I have arrived at Endstage COPD with phenotype of Chronic Bronchitis.....it seems that all day long all I do is attempt to expectorate phlegm and after all I get maybe a 45 minute relief before having to start again. I use Inhalers, Albuterol & Breztri , Nebulized Albuterol, Hyper-Sal. I have a Smart-Vest, suction machine. And a son that lives at home that is able to do chest percussion if the Aerobiki does work. So I am well equipped. I'm 77 y/o, O2 at 3 1/2-5 liters depending on my activity level. I am not frail and worked the gym with a trainer (ex-body builder) 3 x a week. Had a significant decline in lung function over the past 4 months. Of course at this point I have depression and anxiety and truly would like to leave this world...... I just don't seem to be able to muster up any hope from the situation. Any words of wisdom, encouragement..... I am a widow & not particularly close to my two children both of whom are close, one in fact lives with me. Please no thoughts of physician intervention except for my Pulmo and no Spiritual Inspiration...that is simply not where I am in this stage of my life (as short as it may be).