Should I Increase Oxygen During Wildfire Smoke?

No, you should not automatically increase your oxygen flow rate simply because there is a wildfire smoke warning ^[1]. Supplemental oxygen is prescribed to treat low blood oxygen levels (hypoxemia), but it does not protect your lungs from inhaling harmful smoke particles ^[2]. You should only increase your oxygen if your pulse oximeter shows that your oxygen saturation levels have dropped below the target set by your doctor, or if you are following a specific plan provided by your care team ^[3].

Wildfire smoke contains tiny particles called fine particulate matter (PM2.5). When inhaled, these particles travel deep into the air sacs of your lungs (alveoli) ^[4]. For people with Idiopathic Pulmonary Fibrosis (IPF), breathing in these particles can trigger severe inflammation, worsen daily symptoms, and increase the risk of a dangerous complication known as an acute exacerbation ^[5][6].

Because oxygen delivery systems do not filter out air pollution, turning up your oxygen will not stop these particles from causing damage ^[4]. Furthermore, using more oxygen than your body actually needs does not provide additional benefits and carries its own risks ^[3]. For instance, excess oxygen can sometimes cause oxygen toxicity or, in some individuals, suppress the natural drive to breathe ^[7].

Instead of turning up your oxygen flow as a first response, your focus should be on minimizing your exposure to the smoke ^[8][9].

How to Protect Your Lungs During Smoke Warnings

Since extra oxygen cannot act as a shield against air pollution, you need to rely on environmental protections and practical safety measures to keep your lungs safe ^[10]:

• Stay indoors: Keep all windows and doors closed to minimize the amount of outdoor air entering your home ^[5].
• Use HEPA filtration: Run a high-efficiency particulate air (HEPA) purifier in the rooms where you spend the most time ^[5]. This helps capture PM2.5 particles that seep indoors.
• Prepare for power outages: Wildfires often cause rolling blackouts. If you rely on a home oxygen concentrator, losing power is a medical emergency ^[5]. Always maintain a backup supply of portable oxygen cylinders that can last you several days.
• Wear protective masks carefully: If you absolutely must go outside, wear a well-fitting N95 mask ^[5]. Note for oxygen users: Wearing an N95 mask over nasal cannula tubing compromises the tight facial seal required for the mask to filter out PM2.5 particles ^[11]. Secure the mask as tightly as possible over the tubing, but remember that the seal will not be perfect. Because of this, staying indoors is always your safest option. Additionally, an N95 mask can increase your work of breathing, so pace yourself and monitor your oxygen levels closely.
• Practice fire safety: Keep your oxygen equipment well away from any heat or open flames, as concentrated oxygen is highly flammable ^[10].

When to Adjust Your Oxygen

If poor air quality triggers increased breathlessness, use your pulse oximeter to check your levels ^[2]. If your reading drops below the target range prescribed by your doctor (often around 88% to 90%), follow their specific instructions for increasing your flow rate to get your levels back into the safe zone ^[12].

It is critical to remember that a sudden drop in your oxygen levels, a severe worsening of shortness of breath, or a new cough during a wildfire event could be signs of an acute exacerbation of IPF (a sudden and rapid worsening of the disease) ^[13][14]. This is a medical emergency ^[15].

If you find that you need more oxygen than usual to maintain your target numbers, or if you cannot get your numbers up despite adjusting your flow rate, contact your pulmonologist immediately or seek emergency medical care ^[16].