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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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I think this is good information. I attend rehab three days a week and do exercise at home the other days. Oxygen at night and with exertion during the day. I also have pulmonary hypertension, so balancing the two conditions is important. I believe moderate exercise is good for ALL people, especially as we get older. Pulse oxygen measure is only part of the assessment of a person's condition, at rest and during activity!
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2 Reactions@roberthoneywell
I have just been diagnosed with mod/severe COPD in addition to Bronchiectasis and asthma. I am reluctant these days to use my oxometer because it unnerves me when it keeps beeping as under 94. It was down to 85 the other night! It is often 92/93...but then goes up around 95/96 as well. I am not wanting to go on oxygen...and I don't know when it is advised. I am pretty fit and keep busy...gym 4 times a week and occasional 10k walk, so maybe this is saving me
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2 ReactionsHi.
Question for you.
Should COPD patients being administered oxygen have an upper alarm limit set?
Many thanks for your help.
My stats often run 97 to 100, on oxygen 24/7, at 4 , 4.5 when walking on pad walker. I drink a lot of water have acid reflux have had barium swallow and modified which shows food sometimes is slow to go down do eat small portions small bite now I have lost from 155 to 122 since August. Drink nothing but water. Walk you loose what you put in. This makes no sense. Have a endoscopic coming up soon.
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2 Reactions@narelled23 I’m lucky I walk 2k steps a day and still don’t need oxygen. Also, occasionally mine will go to 85 but usually stays right up around 95. Figure that out.
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4 Reactions@narelled23 I was much like you until last summer, when I suddenly needed to be on oxygen all the time. I saw the pulmonary people and they didn't seem concerned, but they offered me the rehab, which I declined because it's a long way to drive. I need to get more exercise at home. Also, my oxometer blinks when it is below 85 when I don't seem to be having any unusual symptoms, but then it will jump up to mid 90"s.
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3 Reactions@roberthoneywel
I am presuming exercise and fitness help avoid need for oxygen. No one has told me anything about when one might be prescribed oxygen.
Yes I was shocked to see the reading of 85 without any obvious shortness of breath.
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2 Reactions@tjphillipp
I find it difficult to understand. It can be low with no obvious shortness of breath and when not low can experience shortness of breath.
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2 Reactions@snoots
Are you aware of the capsule endoscopy?
It's pretty much non-invasive.
Might be an option.
No anesthesia needed.
Good luck
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2 Reactions@narelled23
I’m sure other things come into play. I’m not sure but our hearts most likely come into the picture. Especially if you have low ejection fraction.
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2 Reactions