A Brief History of Oxygen Therapy, Part 1 Print E-mail



A critical turning point in treating COPD patients has been the availability of oxygen equipment for use outside the hospital. First came the large oxygen containers with long tubes that enable advanced COPD patients to move around their homes while breathing supplemental oxygen. Then came portable units that opened the outside world for them.

Each advance in providing regular adequate oxygen represents a major improvement in health and lifestyle for these patients. Body and brain function far more effectively and the heart is healthier. They also restore a critical degree of self-sufficiency and independence by allowing these patients to resume basic self-care and home-care responsibilities and involvement in valued activities outside their home. In sum, these advances improve the length and quality of their future.

Portable oxygen equipmentallowing the patient to move about (ambulate) freelyhas substantially extended the limits of medical care available to advanced COPD patients. Two major conferences published this statement: "The exercise occasioned by ambulation for all daily activities both in and out of the home is a major component in the standard of care and rehabilitation (our emphasis) for patients with advanced chronic obstructive pulmonary disease."

Combustionthe process by which fire burnsand respiration in our cells are similar processes. They both burn oxygen to produce energy. Combustion's energy takes the form of heat. Cellular respiration's energy is the vital force that powers life. Awareness of this similarity has been part of mankind's knowledge since ancient times. Efforts to understand its basis eventually unlocked the door to understanding how and why breathing keeps us alive.

The early Romans were the first to write of the relationship between fire and breathing. Vitruvius, ancient architect and engineer, described how deep-well diggers used fire's need for oxygen to see if a well shaft contained enough fresh air for safety. If a lamp lowered to the bottom continued to burn, they knew it was safe to descend. Galen, the Roman Empire's foremost physician, directly compared respiration to a flame. Our language has handed down this analogy between respiration and combustion with such phrases as "flame of life," "fire of life," and "vital flame."

When seventeenth-century scientist finally began to understand why they are so similar, the accurate understanding of breathing became possible. John Mayow, born in London in 1643 and a graduate of Oxford University, made perhaps the most important of these early contributions. Others had already shown that something in the air is essential for combustion, but it was Mayow who first theorized that the air we breathe contains something specifica "nitro-aereal spirit"essential to both fire and respiration.

He demonstrated this by placing each of two animals in separate airtight glass containers. To one he also added a fire-burning lamp. The animal in the container always died first.

Mayow made his glass containers airtight by placing the opening over water, which creates a vacuum seal. He didn't know the water was also absorbing carbon dioxide, the by-product of oxygen use. But this explains why Mayow always found substantially less air in a container after the flame went out and the animal died. He had clearly demonstrated that something from the air was used during these two processes, even though he did not understand what his "nitro-aereal particles" really were.

This "something" turned out to be oxygen. It was first identifiedindependentlyby Dr. Joseph Priestly of England and Dr. Carl Wilhelm Scheele of Sweden. But it was the French scientist Antoine Laurent Lavoisier who named it, and put together the pieces to explain the true nature of respiration and combustion. Lavoisier summarized his two basic findings: "(1) Respiration affects only the respirable air; the rest of the air nitrogen remains unchanged. (2) Animals shut up in a confined atmosphere succumb, so soon as they have absorbed or converted into 'aeriform calcic acid' carbon dioxide the greater part of the respirable portion of the atmosphere, leaving the remainder." The fact that using this "eminently respirable air" produced acid led Lavoiseir to name the gas oxygine. Typical for his time, he had turned to ancient Greek, combining the words for "acid" and "beget" (or "produce").

Then everyone jumped on the bandwagon. Oxygen was hailed as a panacea, and indiscriminately prescribed to cure every problem from infertility to hysteria. Because its frequent inappropriate use led to many apparent "failures," oxygen was eventually branded a hoax. By the end of the nineteenth century, it had fallen into clinical disrepute.

But that soon changed dramatically, all because the airplaneinvented early in the twentieth centurybecame a highly successful fighting instrument. Pilots in both world wars were venturing up into an environment where available oxygen was often inadequate. The sometimes profound impact on their thoughts, abilities, and temperament touched off a research explosion, with growth of a solid, extensive body of knowledge concerning the effects of oxygenand its lack.

The two-pronged conclusion with basic consequences for medical treatment was that: (1) reducing the oxygen we normally breathe impairs us physically, mentally, and emotionally; and (2) these harmful consequences can be reversed by carefully adding oxygen to the environment.

The first major medical success for oxygen was in treating pneumonia. In the second decade of our century, doctors learned that the pneumonia symptoms reflecting low oxygencyanosis (bluish tint to lips and nails), tachycardia (racing heart rate), delirium, and comafrequently disappeared within just a few hours after beginning oxygen therapy. Before long they also realized that patients on supplemental oxygenwhich relieved them of the burden of inadequate oxygenhad a much better chance of surviving their pneumonia. In 1921, an expert in treating pneumonia wrote that oxygen therapy to prevent hypoxia "... is perhaps the most important factor in the treatment of pneumonia, apart from the specific cure of the infection. ..."

Dr. Alvan Barach of New York City pioneered the broader use of oxygen in medicine, going from lobar pneumonia to cor pulmonale. In 1936, he wrote that "oxygen therapy in suitable cases (of cor pulmonale) relieves difficult breathing, restores strength and helps reduce the swelling of the patient's legs and back." He noted, too, that oxygen helped relieve these patients' dyspnea during activity.


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