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Deborah Leader, RN

The Dangers of Smoking and LTOT

By December 14, 2010

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A couple of years ago while working for a home health agency in Riverside County, I arrived at a patient's home who had severe COPD. She had just gotten out of the hospital for COPD exacerbation and I was there to do a follow-up and make sure she was adequately managing her medications and home oxygen.

As I began my assessment, to my dismay she lit up a cigarette while wearing her oxygen cannula. When I kindly asked her to put it out, she replied "this is my house and I will smoke if I want".  I agreed with her that yes, it was her house, but that it was unsafe for both she and I if she lit up while attached to her oxygen and that if she did not put the cigarette out, I would have to discontinue my visit. Although she did extinguish her cigarette, the story remains fresh in my mind to this day as deaths due to cigarette smoking and oxygen are on the rise.

According to the CDC, approximately 1 million people in the United States receive long-term oxygen therapy, (LTOT) most of whom suffer from chronic lung disease. Between 2000 and 2007, the CDC conducted a study involving four states: Maine, Massachusetts, New Hampshire and Oklahoma. A total of 38 deaths were identified during this time frame involving fires: five in Maine, three in New Hampshire,  11 in Massachusetts and 19 in Oklahoma. Of these, 34 (89%) of the people who died were on LTOT and were smoking at the time the fire started.

Fires related to smoking are the leading cause of house fire fatalities in the United States. Although the precise number is unknown, the CDC estimates that between 10% to 43% of patients using LTOT at home continue to smoke in its presence placing themselves and others in the home in great danger.

If you are using LTOT, here are some helpful safety tips:

  • Do NOT use oxygen around open flames, such as matches, cigarette lighters, candles or cigarettes.
  • Do NOT use oxygen around other sources of heat, such as electric or gas heaters and/or stoves.
  • If you are using supplemental oxygen, avoid using lotions or creams containing petroleum -- the combustion of flammable products containing petroleum can also be supported by the presence of oxygen.
  • Store oxygen cylinders safely in a secure, upright position in an approved place for storage.
  • Turn oxygen supply valves off when not in use.
  • Pay close attention to the safety instructions recommended by your oxygen supply company, regarding safe usage and storage of supplemental oxygen.

For more information, read Oxygen Therapy and COPD.

Are you a smoker who smokes while using oxygen? Please take the attached, anonymous poll.


CDC MMWR. Fatal Fires Associated with Smoking During Long-Term Oxygen Therapy --- Maine, Massachusetts, New Hampshire, and Oklahoma, 2000--2007. August 8, 2008 / 57(31);852-854.

December 16, 2010 at 8:58 am
(1) Bill Hawker says:

You have raised a critical point. As a former sales director and then chief operating oficer for a home medical equipment company, I developed an oxygen safety program built around this dilemna. According to the National Fire Protection Association, one in four oxygen-related fires results in death, and there are about 186 oxygen-related fires in the U.S. annually. There are many addtional ways to protect oxygen users — for instance does the home care company CHECK the smoke detector to see if it is acutally working? Is the physician made aware of the fact that the patient is using oxygen whille smoking? Has the fire department been notified that an oxygen system exists at the user’s residence? These are just a few of the many things I developed for the oxygen safety progrm aimed at saving lives. I am glad you brought this situation to light. Keep up the good work.

December 20, 2010 at 9:00 am
(2) ElectronicCigFan says:

I agree, cigarettes are so dangerous for your health, not only this, but its completely unfair to inflict the hazards of smoking onto others through passive smoking.

December 20, 2010 at 11:33 pm
(3) copd says:

Bill, do you have this information in a published paper that I could read. Please send it via email to copd.guideataboutdotcom. I took out the symbols to reduce spam.

December 23, 2010 at 11:11 am
(4) Alan Siemering says:

Where is the poll that is mentioned at the end of this article? I would like to take it. I have COPD and am on oxygen full time. I am also a smoker. Although I know better, I sometimes smoke with the cannula still in my nose. I cannot justify this, but I wonder if the extra oxygen counteracts, to any extent, the carbon dioxide from the smoke going into my lungs?

December 23, 2010 at 11:15 am
(5) Michael5 says:

Anyone who doesn’t stop smoking after they learn they have COPD is what is hard for me to believe. I smoked for 39 years until I learned I had it. And I used the patch to quit. People can say what they want about how hard it is to kick the control but for me I want enjoy living as long as I can. Living is fun.
I just read last night Spain as of Jan. 2 will prohibit smoking in bars and restaurants. I applaud Spain for helping make the world a more smoke free society.

December 23, 2010 at 11:47 am
(6) cg says:

Smokers – Please read:

Rosemarie’s Story – by Rosemarie Leatham, also known as Whitedove, a contributor to the COPD-International.com library.

Her article “Rosemarie’s Story” is a courageous accounting of her life threatening experience with cigarettes, smoking and O2


December 23, 2010 at 1:32 pm
(7) copd says:

Alan, the poll is at the top of the blog article to the right.

December 25, 2010 at 4:13 pm
(8) Alan Siemering says:

Thanks. I found it. I was looking for a long survey of some sort, I guess.

December 27, 2010 at 11:43 am
(9) Nuala says:

My brother died this July from lung cancer and advanced COPD.
He had long broken the cigarette habitand was just 2 monts short of his 85th birthday. Yhe idea od amoking with oxygen in the and while using it is shocking. I believe this happens more than we know. I always think of it when i hear of an elderly person being rescued from a fire. Was oxygen involved? If it should happen again I think you should call the local Fire dept.
They may shock the smoker into a more safe situation

February 28, 2011 at 3:27 am
(10) matt says:

I’m a cna @ a nursing home. 1 of my favorite residents decided tosneek out in the middle of nite shift at the home left his oxygen on full blast @ 6 litres of o2 and sure enough he caught on fire and died in result. it was very tragic and I will greatly miss him.

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