Oxygen comes in handy at 35,000 feet

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Reporter’s ‘experiment’ of going solo lasts only 20 minutes

When Gordon Allison travels by airline, he uses the Inogen-brand oxygen concentrator

By Gordon Allison, Jr. | Technical Engineer

Editor’s Note: Last week in Part One, we examined oxygen for treating sleep apnea.  Here, we look into using oxygen concentrators for airline travel. Next week, we explore the need for oxygen as people grow older.

When we moved to Colorado in the late 1980s, my hemoglobin rose as we acclimated to high altitude.  Adult males at altitudes of 1,000 feet or less have a hemoglobin level of approximately 13 to 16.5 grams/deciLiter (gm/dL).  When you live at high altitudes such as 5,000 feet above mean sea level (or higher) the body makes more hemoglobin since the high altitude air is “thin” – meaning there is 20 percent less oxygen coming into our lungs.

The body compensates for this decrease in oxygen by increasing hemoglobin levels to around 18 or 18.5 gm/dL.  In my case, I have anemia as well – so I have to take an iron supplement.


In Colorado, my hemoglobin was adequate for high altitude, but around the mid 1990s my hemoglobin started its long slide into the 13 gm/dL range.  The result was that I got tired and had a hard time working on things – low strength.

Climbing stairs from the basement to the ground floor was cause for me to stop four or five times to catch my breath!  Several friends who were on oxygen had either concentrators or huge stainless steel tanks of liquid oxygen –  some with up to 100 feet of tubing to feed the cannula.

My friends with the liquid oxygen tanks could use them to fill a small, lightweight unit, which supplied oxygen while you were out and about.  I didn’t want to remain in Colorado and be attached to a concentrator or huge tanks of liquid oxygen.  After we moved to  Arapahoe, we took a trip to a higher elevation – Emory, Virgina — for a function at Emory & Henry College where Mom and Dad went to school.  I was able to get along by using oxygen at night and controlling my daytime movements so as not to overexert. This worked out OK. The elevation there was about 1100 feet.

Air is composed of about 78 percent nitrogen and 20. 5 percent oxygen.  Believe it or not, Argon gas contributes 0.9 percent to the air mixture.  Carbon Dioxide contributes about 0.4 percent  All these values are based on DRY air.  A concentrator pressurizes what are called sieve beds, which contain a material that when pressurized to 20 psi, they absorb the nitrogen and pass the oxygen to the cannula.  Then the nitrogen is released into the room air while the next bed is charged.  Expect oxygen purity to be between 89 to 93 percent!  In Denver, I had a technician who rebuilt my sieve beds so I got 96 percent pure oxygen!  Any concentrator should seal off the sieve beds when the concentrator is turned off.  Otherwise, water vapor will decrease the effectiveness of the sieve bed material.

Last year, we flew back to Denver, the “mile high city” for a double memorial service.  To survive in Denver, I had to have oxygen 24/7.  And yes, 2 liters/minute of oxygen was adequate.  I also knew I’d need oxygen on the planes since the airline cabins are pressurized to maintain an altitude of 8,000 feet.  In the past, I had used a small concentrator, but it only ran for 45 minutes on each of its two batteries.  This would not work! So I purchased a new portable concentrator and then researched the airline policies for using an oxygen concentrator on an airliner.  Oxygen is considered a medicine and as such it requires a prescription from your family doctor or pulmonologist.

Here are the rules for passengers on an airline flight: The concentrator brand and model has to be approved by the FAA for use without interfering with the aircraft’s navigational equipment.  Make sure the concentrator will put out adequate oxygen at a minimum of 10,000 feet elevation.  One airline required a form be completed showing make, model, and hours of operation at 2 liters/minute, and the airline specified the amount of batteries needed for each segment of the flight including the layover time.  I also needed a letter from my family physician saying I was familiar with the warning signs and knew how to operate the device.  You may not sit in an exit row. You will likely be given a window seat so other passengers don’t trip over your cannula.  The airlines prefer you to be at the back of the airplane so you are out of the way.  If you notify the airline you need a concentrator, you will get a pass so the equipment case does not count as one of your carry-on bags.

On the way back to North Carolina, I ran an experiment to see how long I could last without the concentrator while the airplane cruised at 35,000 feet. The answer? Only 20 minutes?   When I returned to my seat, I had to turn up the concentrator to 3 liters/minute for half an hour until my O2 saturation was back in the 96 percent region.  Then I resumed the 2 liters/minute rate of flow.  If you are using oxygen, you should take a personal pulse ox with you to check that your concentrator is working and you are getting adequate oxygen.  Do NOT let Transportation Security Agency take your pulse ox away from you. Never leave it with your concentrator!  I lost my $200 unit in Denver.  I now use a cheap pulse ox, realizing it is for sports use only and not medical.  It may be off by a couple percent, but it is close enough. Take your pulse ox to your next medical appointment and check readings to see how accurate your unit is.