Why Oxygen Stigma Persists, With Mike Hess, MPH

In recognition of World Oxygen Day on October 2, 2026, Mike Hess, MPH, RRT, RPFT, senior director of advocacy and regulatory affairs at the COPD Foundation, told HCPLive pulmonologists can help close persistent gaps in supplemental oxygen therapy access, education, and stigma.¹

The COPD Foundation observes World Oxygen Day each year on October 2, or “O-2 Day,” as part of its Oxygen 360 initiative, which Hess leads.¹ Supplemental oxygen is among the most commonly prescribed therapies in pulmonology, yet patients continue to report problems with equipment, delivery, and training.² Hess, a registered respiratory therapist and former chronic disease coordinator at WMed Health in Kalamazoo, Michigan, framed the observance as a way to bring these barriers to the attention of clinicians, patients, and the public.

"There's still a lot of misconceptions about it,” he said. “There's a lot of misunderstanding about it, both in the patient community and in the general public, about how best to use it and what it means. World Oxygen Day is intended to try and cut through some of that.”

Oxygen Therapy Stigma and Patient Phenotypes in Pulmonology

Hess said patients frequently interpret a new oxygen prescription as a sign of approaching end of life or as a mandate to stay home and conserve energy. He said pulmonologists may underestimate how widespread this belief is among their patients, creating an education gap at the point of prescribing.

"It's very important to encourage people to continue to live their best life, as we say," said Hess. "Stay as active as possible, as engaged as possible."

Hess also cautioned against a 1-size-fits-all approach to oxygen delivery. Patients with pulmonary fibrosis often have different oxygenation needs than patients with COPD, and patients with pulmonary hypertension tend to be younger and more often female, with some managing oxygen therapy alongside raising families.

SOAR Act and Medicare Barriers to Supplemental Oxygen Access

The Supplemental Oxygen Access Reform (SOAR) Act, reintroduced in April 2025 as H.R. 2902 and S. 1406, has the backing of roughly 3 dozen patient and professional advocacy organizations, according to Hess.³ Hess said 30 to 40 years of Medicare reimbursement cuts have made liquid oxygen virtually inaccessible for patients outside the Veterans Affairs system.

Training represents a second gap. In an American Thoracic Society Nursing Assembly survey of 1926 supplemental oxygen users, most respondents received instruction on their equipment from an oxygen delivery person rather than a health care professional.²

"It's not fair to pulmonologists who really want to help their patients adhere to their therapy [and] stay active," said Hess.

The bill would establish separate, inflation-indexed Medicare payments for liquid and nonliquid oxygen, remove oxygen from the competitive bidding program, and add a payment for respiratory therapist services such as home assessments and education.³ It would also require a standardized electronic ordering template to guard against fraud and abuse.

"Ultimately it aims to make medical oxygen therapy more patient centric, rather than just getting whatever is available,” Hess said.

Oxygen 360 Resources for Clinicians and Patients

Oxygen 360 serves as the umbrella for the foundation's oxygen initiatives, including World Oxygen Day and 2 monthly discussion groups.¹ One group convenes innovators and stakeholders across medical oxygen globally, building on the Lancet Global Health Commission on Medical Oxygen Security, whose February 2025 report highlighted World Oxygen Day as a platform for unified advocacy.⁴ The second, Oxy Talk, gives patients and caregivers new to oxygen therapy a forum to ask clinicians and experienced users about stigma, tubing management, cooking, and showering.

The foundation has also studied "noncentrators," devices sold online without a prescription and marketed with claims Hess described as “fantastical.” He said these products appeal to patients without access to standard equipment who may not recognize the difference between an over-the-counter device and true medical equipment.

Hess said the COPD Foundation continues to seek organizational partners in medical oxygen, with webinars and social media campaigns planned for observance of World Oxygen Day.

References

1. World Oxygen Day. COPD Foundation. Accessed October 2, 2026. https://www.copdfoundation.org/Take-Action/Get-Involved/World-Oxygen-Day.aspx
2. Jacobs SS, Lindell KO, Collins EG, et al. Patient perceptions of the adequacy of supplemental oxygen therapy: results of the American Thoracic Society Nursing Assembly Oxygen Working Group Survey. Ann Am Thorac Soc. 2018;15(1):24-32. doi:10.1513/AnnalsATS.201703-209OC
3. SOAR Act of 2025, HR 2902, 119th Cong (2025). Accessed October 2, 2026. https://www.congress.gov/119/bills/hr2902/BILLS-119hr2902ih.pdf
4. Graham HR, King C, Rahman AE, et al. Reducing global inequities in medical oxygen access: the Lancet Global Health Commission on medical oxygen security. Lancet Glob Health. 2025;13(3):e528-e584. doi:10.1016/S2214-109X(24)00496-0