How to Choose: Nasal Cannula or Portable Oxygen Mask for COPD Treatment

Here’s a helpful summary of the pros and cons of choosing between a nasal cannula and a portable oxygen mask for COPD.

Nasal cannulas and face masks are two ways you might receive oxygen therapy. Choosing which device is best for you can be tricky. Both have pros, cons, and limitations.

To help you understand oxygen therapy, sometimes called oxygen supplementation, I’ll explain what you should know about our air as it is, followed by the differences between nasal cannulas and portable oxygen masks.

Join the free COPD community!

Connect with thousands of members and find support through daily live chats, curated resources, and one-to-one messaging.

Sign up

What’s in our air, and how much oxygen do we actually get?

Experts believe that the average air we breathe (or room air) has about 21% oxygen. Any oxygen you receive from oxygen therapy devices takes this into account.

Doctors can measure the amount of oxygen in your blood or the amount of oxygen your red blood cells are carrying. This test is called pulse oximetry. A pulse oximeter is a small sensor that emits light through the body part it’s attached to — like your finger. They’re available at a doctor’s office and for home use.

Your oxygen levels usually show up as a range because oxygen needs can change depending on what you’re doing throughout the day.

Respiratory experts suggest the range for people living with COPD is 88% to 92%.

Pro tip: Nail polish or artificial nails can alter your results, so try the test without if you usually have your nails done.

Your doctor might recommend oxygen therapy if you’re unable to maintain a spirometry reading above 88% on room air when at rest or if your number drops too low while walking for about 6 minutes.

The goal of oxygen therapy is to maintain good levels of oxygen for you to function while still providing enough for the body’s other vital organs.

Nasal cannulas and face masks are both devices used to deliver oxygen to people who need it. But how they look, feel, and work varies. Let’s take a look at each, with insight from people living with COPD.

Nasal cannula

A nasal cannula is a flexible, plastic tube that wraps around your ears and has two prongs that go inside each nostril. It’s more flexible than a face mask.

When using a nasal cannula, the points of irritation are usually behind the ears, where the tubing loops around and holds the device on your face. Also, your nares, or the inside of your nostrils, can get dry and even crack or bleed from this continuous, targeted air flow directly into them.

A traditional nasal cannula can provide up to about 4 to 6 liters per minute (LPM), but experts suggest it may be as little as 1 LPM to 2 LPM.

The benefits of a nasal cannula are that you can speak and eat without removing the device. Nasal cannulas are commonly used when you need low to moderate levels of oxygen therapy (less than 6 LPM).

Pro tip: If you’re unsure if your oxygen is on, put the prongs in a glass of water and check for bubbles.

Face mask

A face mask is made of medium-strength plastic with an elastic band that wraps around the back of your head. It’s less flexible than a nasal cannula and covers the mouth and nose.

There might be some discomfort or irritation on the bridge of your nose, where the elastic band causes friction behind the ears or on the back of the head.

Face masks are commonly used when you need moderate or higher levels of oxygen therapy or when you cannot tolerate a nasal cannula. A simple face mask can often deliver about 6 to 10 LPM.

Since a face mask delivers oxygen to both the nose and mouth, you might be able to take in more with each breath. However, the mask needs to be removed for eating and may interfere with speaking.

A face mask may feel confining to someone who feels claustrophobic with it on. People with larger or smaller heads may have more trouble fitting this device comfortably. 

Depending on how much oxygen you require, some people can even switch between a nasal cannula and a face mask throughout the day to fit their oxygen needs and lifestyle. Switching, when feasible, can also allow breaks from the known pressure points (behind the head or the ears) and limitations (eating and speaking) of each device.

Typically, both devices fit on the same oxygen delivery device and can be easily swapped out. Ask your doctor if this is an option for you — this isn’t something you can do without the direction of your pulmonologist or healthcare team.

Takeaway

Oxygen therapy isn’t just for people with COPD. It might also be used to treat other chronic conditions, such as asthma and cystic fibrosis, for babies born with underdeveloped lungs, and during illnesses such as pneumonia or COVID-19.

The main differences between a nasal cannula and a face mask for oxygen supplementation are the delivery method, the amount of oxygen delivered, and how they fit on one’s face.

Only you and your doctors can determine which is right for you and your lifestyle.