Portable Concentrator Therapy Guide Guidance for patients requiring long-term, supplemental oxygen . Table of Contents

Part One: 101 Part Two: Oxygen Concentrators Part Three: Portable Oxygen Concentrators Part Four: Which Oxygen Concentrator is Right For You?

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Welcome!

OxygenDirect is pleased to provide this educational guide for current and potential patients to understand the benefits of oxygen therapy—and specifically portable oxygen concentrators. We intend to expand patients’ knowledge and appreciation of advancements in technology that are now available.

This document is designed to complement the information provided by a doctor or healthcare provider when discussing oxygen therapy options.

Who is OxygenDirect?

OxygenDirect is dedicated to helping oxygen therapy patients breathe easier without interfering with lifestyles and daily activities. We offer a wide selection of portable and home oxygen products and accessories, plus a diverse range of CPAP machines and accessories. Our OxygenDirect Product Specialists can help evaluate patients’ oxygen needs and varying product features to ultimately arrive at a product that perfectly fits a wide range of lifestyles and budgets.

Disclaimer: The information contained in this document is general in nature and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a /medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this document.

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How Your Body Uses Oxygen

Simply put, when your body is functioning properly, the oxygen you inhale from the air passes through your lungs into the bloodstream. The blood carries oxygen to cells throughout the body, where it helps convert nutrients into usable energy. If your lungs aren’t performing at full capacity, you may not be able to receive the full amount of oxygen that each breath would normally supply—resulting in a condition known as hypoxemia.

Low blood oxygen levels can result in abnormal circulation and cause the following symptoms: DID YOU KNOW? On average, the • Shortness of breath air we breathe is • Headache comprised of roughly • Rapid breathing 78% and • Dizziness only 21% oxygen! • Chest pain • High blood

What is Oxygen Therapy?

Oxygen therapy is a treatment that delivers supplemental, medical-grade oxygen to patients who are unable to naturally absorb the amount of oxygen their bodies need. Supplemental oxygen allows the natural processes in our bodies to work more efficiently, decrease strain, and increase overall health. Although roughly 1 in 7 Americans will require oxygen therapy in their lifetime, recent innovations and advancements in technology make it easier than ever to supplement oxygen needs without sacrificing freedom and independence.

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Types of Oxygen Delivery Systems

Oxygen can be delivered to patients through several types of methods. Generally, new oxygen patients will be recommended or provided a system that covers basic oxygen needs but may not provide the patient with the flexibility their lifestyle demands. It’s important to understand the available types of oxygen delivery systems to make an informed decision and find a that will suit your medical condition, lifestyle, and budget.

Oxygen Tanks

Tanks of compressed oxygen gas are the most common method of oxygen therapy. While relatively inexpensive, oxygen tanks are limited by a finite capacity (the size of the tank) this can produce an issue for portability. This means, despite their prevalence as a therapy choice, oxygen tanks are extremely limiting for patients and only allow for travel over short distances without several cumbersome, backup tanks. It is also against FAA regulations to travel on an airplane with a compressed gas tank.

Liquid Oxygen Systems

Oxygen can be stored in a form and converted to a gaseous state before patient delivery. While this approach has the benefit of lighter canisters it is also the most expensive option available as refills require authorized containers and personnel. Similar to traditional tanks, liquid oxygen also cannot be taken on an airplane and has a relatively short travel distance with ambulatory canisters only providing roughly 2-6 hours of oxygen depending on the prescribed flow rate and device used.

Oxygen Concentrator Systems

Oxygen concentrators extract oxygen from the surrounding air, concentrate it, and deliver it as pure, medical-grade level oxygen. No tanks or refills—all that is required for oxygen concentrators to operate is a source of power. This method is by far the most popular choice for patients that are new to oxygen or require oxygen while they sleep. Available as both stationary and (FAA-friendly) portable units, oxygen concentrators provide not only the most convenient method of oxygen delivery but also allow patients to enjoy life to the fullest without oxygen getting in the way!

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Frequently Asked Questions

Why do I need a prescription for oxygen?

Medical-grade oxygen is treated as a medication, and just like any other medication, your doctor must prescribe it with specific instructions regarding how much to use and how often.

A prescription typically includes the following information:

• Specifics about oxygen usage/frequency • Recommended dosage (liters per minute) • Defined delivery device and settings

Will I become dependent on oxygen?

A common myth is that oxygen is addictive and by using supplemental oxygen, you will become more dependent upon it and subsequently weaken your natural ability to process oxygen. This is simply not true. Using supplemental oxygen will allow the natural processes in your body to work more efficiently, decrease excess strain, and increase your overall health.

KEY TERMS

Alveoli (al-VEE-o-lye) Tiny air sacs in the lungs.

Hypoxia A medical condition in which patients are unable to take in the full amount of oxygen that each breath would normally supply.

Long-Term Oxygen Well established as the standard form of treatment for patients with low Therapy oxygen levels in the blood.

Pulse Oximeter A small device that clips on the finger to measure blood oxygen levels. This is the least intrusive method to measure blood oxygen.

Hypoxemia An abnormally low level of oxygen in the blood. More specifically, it is oxygen deficiency in arterial blood.

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Oxygen Concentrator Systems

Stationary or portable, all oxygen concentrators typically function similarly. The system purifies and concentrates DID YOU KNOW? the surrounding air to supply patients with an endless Oxygen concentrators supply of oxygen, so long as the oxygen concentrator is never require tank refills connected to power. Considering the clear advantages or replacements. over alternative delivery methods, the remainder of this guide will focus on oxygen concentrators, with an in-depth look at portable oxygen concentrators, specifically (page 14).

Oxygen therapy doesn’t have to mean giving up favorite activities. With 1 in 7 Americans requiring it at some point in their lifetime, oxygen concentrator technology is continuing to advance, making units lighter, quieter, and more comfortable than ever.

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How It Works

Unlike traditional oxygen tanks, concentrator systems do not need to store oxygen, but instead, draw air from the patient’s surroundings to provide supplemental oxygen. To understand how this works, it helps to visualize an air conditioner but instead of cooling the air, oxygen concentrators compress and purify the air and remove any elements that may complicate breathing. Regardless of size, oxygen concentrators follow these steps to deliver oxygen to patients.

The concentrator: 1. Pulls in air 2. Compresses the air, while a cooling mechanism reduces overheating 3. Removes nitrogen and other impurities via filter and sieve beds 4. Adapts delivery settings with an electronic interface 5. Delivers purified, medical-grade oxygen to the patient via a tube device placed in the nostrils (nasal cannula)

Pure Oxygen 90%-95%

Flow Meter Four Way Adjusting Selenoid Valve Valve Air Enters

Pressure Regulator Motor & Compressor

80% Nitrogen 20% Oxygen Heat Exchanger Product Tank

Surge Tank

Molecular Seive Beads

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Understanding Oxygen Concentrators DID YOU KNOW? Roughly 1 in 7 Americans While the ability to concentrate oxygen continuously will require oxygen from the surrounding air has been around for therapy at some point in decades, only in recent years has technology their lives. advanced to create lightweight portable oxygen concentrators (POCs).

Key Differences Between Stationary & Portable Concentrators

Stationary

vs.

Portable

Stationary Concentrator Portable Concentrator

Before the invention of small, battery-powered Portable oxygen concentrators (POCs) are concentrators, all oxygen concentrators were designed to travel with patients because they run stationary home units. Ranging in weight from for a limited time on battery power before requiring 30-50 pounds, stationary concentrators are still a recharge. Portable concentrators are also able utilized today for their higher oxygen capacities to run and recharge on AC (wall outlet) or DC and nocturnal usage. In fact, many patients (automobile auxiliary outlet) power. (It’s important typically use both stationary and portable units to to note the battery life of POCs can fluctuate fulfill their oxygen needs and maintain an active, across brands, batteries, and settings.) Most POCs healthy lifestyle. provide pulse dose–short spurts of oxygen when the patient inhales—but some provide both pulse and automatic delivery, also known as continuous flow (more details on next page.)

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Pulse Dose vs. Continuous Flow DID YOU KNOW? Why not have both? There When first considering supplemental oxygen, one are many concentrators on of the first questions you’ll need to answer is: the market that offer both What type of device best fits my needs? The first pulse and continuous flow determining factor is whether you’ll require a pulse in a single machine! or continuous flowing oxygen unit.

What is Pulse Dose? What is Continuous Flow?

Think of pulse dose oxygen therapy as “on- Continuous flow delivery, as it sounds, provides demand oxygen” based on your breathing rate. uninterrupted oxygen at a steady, specific rate When you inhale, a short spurt of oxygen, called regardless of your breathing. Continuous flow is the a , is delivered via a tube device placed most common type of oxygen delivery and most in your nostrils, called a cannula. The bolus is doctors recommend this method if you require released in the first part of your breath—when oxygen at night. it’s needed the most. To understand better, it helps to envision pulse dose as taking a drink through a If pulse dose is akin to sipping through a straw, straw. The amount of fluid and intensity of the “sip” continuous flow can be understood better if you is based entirely on how much you desire. This think about drinking from a water fountain. Water means that instead of oxygen flowing continuously streams at a steady pace whether you’re taking a to your nostrils, you’re able to directly control the drink or not. The same applies to continuous flow flow of oxygen. units, there will naturally be excess oxygen wasted due to the constant state of delivery. Considering the reduced size and weight when compared with traditional continuous oxygen All home (stationary) concentrators operate in concentrators, pulse dose units are ideal if you’re continuous flow delivery and can be a great looking to maintain an active lifestyle. solution if you lead a more relaxed lifestyle or require oxygen at night.

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Frequently Asked Questions

What are the benefits and drawbacks of oxygen therapy?

Research shows using oxygen significantly improves patients’ quality of life and the benefits are usually immediate. Patients have more energy, an increase in overall brain health and functions, and a renewed sense of freedom. A possible downside to oxygen therapy is that some users experience a bit of dryness in their nose or sinuses from receiving oxygen. Patients find they need to experiment with several types of cannulas (the tube device placed in the nostrils to deliver supplemental oxygen) or skin in order to achieve the ideal setup. Fortunately, recent innovations in cannula technology now allow for a softer, cushioned, and more comfortable fit than ever before.

How is oxygen flow measured?

Oxygen is a gas and the flow is measured in liters per minute (LPM). If you require oxygen therapy, your doctor will prescribe you a given oxygen flow rate such as 2 LPM.

Does an oxygen concentrator need servicing?

Not all oxygen concentrators are built the same way and many modern concentrators are designed for the owner to undertake maintenance themselves. Other, more complicated units may need to be brought into your dealer’s location for internal maintenance. Make sure to inquire about ongoing maintenance requirements and packages when speaking with a dealer—both when renting or purchasing a unit.

KEY TERMS

Conserver With pulse flow technology, oxygen can be stored in the conserver to be saved for when your breathing rate increases, you become suddenly active, or whatever the case may be.

DME Durable medical equipment, or DME, is a health insurance term that refers to any equipment that can withstand repeated use, serves a medical purpose, and is not of use to someone without an illness.

Nasal Cannula The hose that passes over the ears, across the cheeks, and into each (kan-u-la) nostril to deliver supplemental oxygen.

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Get Your Life Back!

Portable oxygen concentrator technology is helping millions breathe easier without interfering with lifestyles and daily activities. Quiet, lightweight and travel-friendly, portable oxygen concentrators continuously convert the surrounding air into oxygen and allow oxygen users to continue to enjoy life to the fullest. If you or a loved one is living with a lung condition and requires supplemental oxygen, a portable oxygen concentrator (POC) may be the perfect solution to not only assist breathing but also preserve patient freedom and independence. POCs are designed to follow you anywhere because they’re powered by a battery that’s easily rechargeable via a wall outlet or the DC outlet in your car.

Medicare and private insurance carriers usually offer some type of coverage for oxygen therapy, but unsurprisingly, it varies and can be a little complicated. If you are unsure about your insurance coverage, an OxygenDirect Product Specialist can help figure it out.

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Traveling with a POC DID YOU KNOW? Portable oxygen concentrators are Planning a trip? Talk with significantly lighter in weight than stationary your doctor about your home concentrators. In fact, some units can chosen destination first to be as light as two pounds, with more versatile discuss changes in altitude, units topping out around 12-15 pounds. temperatures, and even dust Needless to say, portable oxygen technology levels that can impact your has opened up the world of travel for patients oxygen delivery. requiring supplemental oxygen.

By Air

The FAA does not permit traditional oxygen tanks or liquid oxygen aboard airplanes, however, portable oxygen concentrators are considered safe and dozens of models and brands are approved. There are a few factors to consider to help you have a safe trip and avoid unnecessary delays or stress. • Talk with your doctor before booking your flight to discuss your oxygen needs and get a physician’s statement expressing your medical requirement to use oxygen. • Check that your concentrator is approved by the FAA and your selected airline. • Consider your battery requirements. Airlines and the FAA both require you to bring batteries sufficient to power your device for 150 percent of the expected maximum flight duration. Never rely on aircraft electrical power to charge your device during a flight.

By Land

Your POC can be powered by either rechargeable lithium-ion batteries or a vehicle’s DC power outlet, so whether you’re running around town or taking a cross-country RV trip, portable oxygen concentrators can give you the freedom to explore without dragging around a cumbersome oxygen tank. If you’re considering travel by bus or train, oxygen systems are much more lenient when compared to flying. It’s a good idea to contact the service provider (e.g., Greyhound, AMTRAK, etc.) at least 48 hours prior to your departure to ensure all necessary assistance is arranged.

By Sea

Generally, cruise lines are very open to varying methods of oxygen therapy. If you’re considering a cruise, reach out to the cruise line when planning your trip because each cruise line has specific guidelines for traveling with oxygen (e.g., a medical release form to clear you for travel).

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Frequently Asked Questions

Can I fly with a POC?

The Federal Aviation Administration (FAA) ruled that all passengers who require oxygen must be allowed to bring FAA-approved POCs on all U.S. aircraft with more than 19 seats. Foreign airlines must also allow portable oxygen concentrators on all flights to and from U.S soil. All OxygenDirect POCs are FAA approved, which means you can safely take it with you when flying.

Are POCs covered by Medicare?

Some POCs are covered by Medicare and many private insurance plans (co-payments and deductibles may apply). All oxygen equipment is eligible for reimbursement with a consumer-directed healthcare account. Contact OxygenDirect if you are unsure whether your insurance will cover some or all of the cost for a POC.

KEY TERMS

FAA Federal Aviation Administration

Hypoxemia Hypoxemia is an abnormally low level of oxygen in the blood. Hypoxemia has many causes, often respiratory disorders, and can cause tissue as the blood is not supplying enough oxygen to the body.

Sieve Bed The sieve bed is the filter inside of an oxygen concentrator which separates out the nitrogen from the oxygen in the air. Most concentrators include two sieve beds.

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Which POC is Right for Me?

DID YOU KNOW? With so many portable oxygen concentrator choices Always work with on the market, it’s easy to become overwhelmed. To your doctor to narrow the options, it’s helpful to prioritize the features understand the best important to you and communicate them to your doctor delivery method and or oxygen therapy product specialist. What does your settings for your prescription dictate? How long should your POC operate needs. between battery charges? What is a comfortable size, weight, and noise level?

Your interests will dictate the concentrator that works best for you. Do you enjoy fitness activities? Are you a social butterfly? Always planning trips? The right system can let you keep up your lifestyle.

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Key Features to Consider When Weighing Your Options

Inogen One G5 Inogen One G4

6 Flow Settings 3 Flow Settings

Compact 4.7 lbs Light Weight 2.8 lbs

Very Quiet 38 dBA Very Quiet 40 dBA

Battery Life Capacity

The battery life of POCs can fluctuate across The oxygen delivered by POCs is measured in brands, batteries, and settings. Typically, the harder LPM (liters per minute) for continuous flow or the a unit is operating the shorter the battery life (e.g., equivalent thereof in ml/min (milliliters per minute) continuous flow requires more battery power than for pulse dose oxygen. Your doctor will prescribe pulse dose). Many units on the market today report an oxygen flow rate, such as 2 liters per minute, that a single, fully charged battery will provide up which means you you will have the equivalent of 2 to 4.7 hours of operation and a double battery will liters of oxygen flowing into your nostrils over the provide up to 10 hours of operation. duration of a minute. Prescriptions typically range from 1 LPM to 10 LPM with over 75% of patients requiring 2 LPM or less.

Size & Weight Noise Level Naturally, POCs are substantially lighter in weight when compared to home concentrators POCs are generally quieter than at-home or alternative oxygen therapy methods. Some of concentrators as they are less powerful and the lightest units available only weigh about 2-4 have a smaller footprint. The sound emitted by pounds or roughly the weight of a pineapple. Keep concentrators ranges from 30 to 60 decibels, which in mind that smaller, lightweight units deliver only can be thought of as a range from a whisper to a pulse dose, typically have limited settings, and soft conversation. If you require oxygen at night, a generally have a lower oxygen capacity. Medium persistent noise may be disturbing for you or your POCs, ranging from 4-10 pounds are still able to partner so it’s important to find the product that be carried along with you and offer higher oxygen best suits your sleeping needs. capacities and longer-lasting batteries than smaller units. Large POCs, anywhere from 10-20 pounds, are often carried around with a mobile cart rather than an over-the-shoulder bag.

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Questions to Review With Your Doctor

If you’re not sure which solution is right for you, it helps to first consider exactly how you would like to use the device and what lifestyle to expect to maintain. Below is a list of questions you can review with your doctor before deciding on the right solution. • What is my required liter flow rate? • Do I regularly use sleep apnea equipment? (APAP, CPAP or BiPAP) • How long of battery life do I require on a daily basis? • How much traveling do I plan on? • How much weight can I comfortably carry with me?

A Note About Using Oxygen at Night

If you require oxygen at night, most physicians recommend a continuous flow (at-home) concentrator. With continuous flow, patients consistently report a quieter experience that meets all oxygen needs with minimal disruption. It’s important to note that stationary, continuous concentrators are powered by plugging into your home’s wall outlet. While most home units are equipped with a power failure alarm, it’s important to have a backup plan in the event of a power outage.

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Frequently Asked Questions

Will I become dependent on oxygen?

A common myth is that oxygen is addictive and by using supplemental oxygen, you will become more dependent upon it and subsequently weaken your natural ability to process oxygen. This is simply not true. Using supplemental oxygen will allow the natural processes in your body to work more efficiently, decrease excess strain, and increase your overall health.

KEY TERMS

Bolus A “shot” of oxygen; one single puff. In the pulse dose method of oxygen delivery (used by most portable concentrators), a single bolus of oxygen is released by the concentrator into your nasal cannula each time you start to take a breath.

Puffer Another term for pulse dose concentrator.

Carry Bags Most POCs come with protective cases, protective covers, or other accessories designed to help you travel with the device.

Carts Wheeled carts are available for units that are too heavy to comfortably be carried over the shoulder.

LPM Liters per minute

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Additional Information to Consider

Lifetime cost and equipment age are primary considerations when evaluating whether to rent or buy a POC. When renting, you aren’t guaranteed a brand new unit. Older concentrators run much more loudly and are less energy-efficient than newer models, which can hike up electricity costs significantly. Because of this, rentals are primarily used to provide short-term oxygen for travel or special occasions.

Portable oxygen concentrators can be expensive so it’s important to examine the total cost of ownership over the full life of your equipment. Rental costs vary, as do insurance coverage amounts and terms. But here’s a typical scenario: on average, renting a POC will cost you $750 per unit every year. Assuming your insurance coverage covers a five-year term, that equates to nearly $4,000 total, and that cost may not include fees from upkeep and maintenance.

Oxygen Therapy & COPD

For many patients with chronic obstructive pulmonary disease (COPD) and severe resting hypoxemia, long-term use of supplemental oxygen (along with medications) is proven to improve lifestyles and help manage symptoms. The ideal type of oxygen therapy system depends on both your individual needs and the advice of your doctor. Talk to your doctor and find out.

Oxygen Safety

Whether you choose an oxygen concentrator, oxygen tanks, or a liquid oxygen system, home oxygen safety should never be overlooked. Although oxygen is a safe, non-flammable gas, it does support combustion, which means things burn more easily and ignite faster in its presence. Review the following tips to stay safe while using oxygen:

• Always keep oxygen equipment at least 5-10 feet away from any source of open flames such as gas stoves, DID YOU KNOW? barbecues, fireplaces, and even candles. Nearly 90% of deaths • Never smoke around oxygen and post ‘NO ’ related to fire and signs around your home to remind family and guests. home oxygen use are • Avoid potential sources of sparks such as hair dryers, caused by smoking! electric blankets, and electric razors. Never smoke or allow • Install and maintain smoke detectors in your home. anyone else to smoke • Inform your power company and fire department that around oxygen. you’re oxygen dependent.

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Oxygen concentrators work by separating nitrogen from oxygen in the surrounding air, allowing patients to inhale FACTORS TO CONSIDER over 95% pure oxygen for therapy purposes. They provide an endless supply of oxygen, so long as the oxygen concentrator is connected to power. There are two types Medical Condition of oxygen concentrators: pulse dose and continuous flow. What is my recommended dosage (liters per A pulse dose machine delivers air to the patient in the form minute)? of short puffs, detecting when the patient is ready to take a Do I require oxygen at night while I sleep? breath. A continuous flow unit produces a steady stream of oxygen and is usually recommended for patients requiring Have I been diagnosed with a lung condition oxygen therapy while they sleep. The type of concentrator or COPD? required will typically be prescribed by a healthcare provider. Will I be using a CPAP Machine?

Have I done a walk-test with a respiratory Going Portable therapist to make sure a POC meets my needs? In the last decade, technology has allowed concentrators to become more portable and energy-efficient. Now, Lifestyle oxygen patients are freed from bulky home units and How much weight can I carry comfortably? are able to resume work, travel, and everyday activities Do I plan on flying with an oxygen accompanied by a portable oxygen concentrator (POC). concentrator? Compact, lightweight, and easy-to-use, POCs are designed to follow patients anywhere because they’re powered by How much noise am I comfortable with? a battery that’s easily rechargeable via a wall outlet or the Am I a light sleeper? DC outlet in a vehicle. Portable oxygen concentrators may be the perfect solution to not only assist breathing but also Do I have a hard time reading small displays? preserve patient freedom and independence. How much battery life do I require on a daily basis? Factors to Consider Budget When researching oxygen therapy solutions, and even Am I able to perform routine maintenance on more specifically oxygen concentrators, the choices facing my unit? patients can be very overwhelming. To begin narrowing the options, consider your medical condition, desired lifestyle, Do I want a warranty? and budget. These are not only great talking points with Will I require replacement parts? your doctor but can also help uncover your priorities when talking with a Product Specialist. Do I require financing options?

LET US HELP! CALL US AT (800) 515-8049 WHO IS OXYGENDIRECT?

OxygenDirect Product Specialists are ready to help you find the OxygenDirect is dedicated to helping oxygen therapy patients perfect oxygen concentrator. After you’ve talked with your breathe easier without interfering with lifestyles and daily doctor and an ideal dosage is prescribed, we help evaluate your activities. We offer a wide selection of portable and home recommended dosage and your oxygen needs to recommend oxygen products and accessories, plus a diverse range of products ideal for your lifestyle and budget. Our team of Product CPAP machines and accessories. Our OxygenDirect Product Specialists provides expert advice and ordering assistance at any Specialists can help evaluate patients’ oxygen needs and point throughout the process. We offer free 2-day shipping on all varying product features to ultimately arrive at a product that concentrators, no sales tax (except N.C.), at very affordable prices. perfectly fits a wide range of lifestyles and budgets.