There’s no getting ‘addicted’ to oxygen
DEAR DR. ROACH: I have COPD and have been on oxygen for about 12 years now. I recently saw a cardiologist for the first time, and he found that I have atrial fibrillation. He added Xarelto and atenolol to my regimen. My heart rate is now steady at 65-70, but my oxygen reserve has disappeared: Any activity drops my oxygen saturation to below 80 per cent. I also take medications for kidney failure, prostate cancer, a thyroid condition and macular degeneration.
I am worried that I may become hooked on oxygen, so I am hesitant to increase my oxygen flow (I normally use two or three litres per minute, and have gone up to four at times). Do you think I need to worry about getting hooked on oxygen? Do you think one of the new medications affected my lung function? Has long-term use of oxygen been studied?
ANSWER: Chronic obstructive pulmonary disease is a progressive disease affecting lung function. It can be slowed only somewhat with currently available medications, and oxygen remains an important therapy for people with severe disease and oxygen levels at or below 88 per cent.
Other treatments are important too, and I particularly want to mention pulmonary rehabilitation (for people with severe symptoms or frequent exacerbations) and exercise. People do not become “addicted” to oxygen. However, the disease can progress to where supplemental oxygen becomes necessary. Then, even small decreases in pulmonary function will cause a big increase in symptoms. Lack of oxygen is hard on the lungs and heart. You shouldn’t try to go without oxygen.
Atrial fibrillation — a chaotic heart rate and lack of rhythm — can cause symptoms of breathlessness, but that usually is worse when the heart rate is fast. Rivaroxaban (Xarelto) is an anticoagulant used to help prevent stroke; it should not affect lung function.
Atenolol, a beta blocker, is used to slow heart rate, but can cause worsening of lung symptoms in some people. It works primarily on the beta-1 receptor, which causes the heart to slow down and beat less strongly, but it also has activity on the beta-2 receptors in the lung, causing constriction of the airways and potentially worsening lung symptoms. However, I don’t see beta blockers lowering oxygen quite so much.
The connection with the new medications makes me concerned you are having a bad reaction to the atenolol. Discuss with the cardiologist how to find an alternative.