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Stage 4: Advanced Oxygen Needs

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This information was reviewed and approved by Jeffrey James Swigris, DO, MS (9/1/2017).

Stage 4 of IPF requires advance oxygen needs, which means needing high-flow oxygen or when a lightweight, portable delivery system is unable to meet a person with IPFs needs. 


  • Work with your health care provider regarding the oxygen prescription change and the best oxygen system to meet your needs for using oxygen as the liter flow increases 24 hours a day. High liter flow is described as greater than 4 liters. Transtracheal oxygen may be an option.

  • Learn about stationary oxygen systems and portable oxygen systems that will meet your oxygen needs at high liter flows.

  • Learn how long the portable oxygen system will last at higher liter flows.

  • Work with the DME company regarding the change in oxygen needs.

  • Use your pulse oximeter to monitor your oxygen level. Maintain an oxygen saturation equal to or greater than 89 percent when you rest and are active.

  • Ask about the medications that may be used for IPF. Learn the dose and time the medicine is taken, how it may be helpful and what side effects to watch for.

  • Talk with your health care provider about palliative care.

  • Your health care provider may talk with you about the possibility of a lung transplant.

  • Remember to stay active and continue living a full life with IPF.


What to expect from the person with IPF in this stage

  • The person with IPF in Stage IV is short of breath with exertion or activity. Even though they need oxygen at rest, they will not usually be short of breath at rest.

  • Cough can be frequent and bothersome. It may only occur when the person with IPF talks for long periods of time or when they are exerting.

  • Fatigue is not uncommon at this stage and can be challenging to treat. Eating well, exercising and getting plenty of high quality sleep can help. Napping is okay and encouraged.

  • High-flow oxygen cannot be delivered by portable oxygen concentrators, so many people with IPF feel even more constrained. Remember, even high-flow oxygen is not a death sentence! Nonetheless, people with IPF may feel afraid, anxious or depressed and be short-tempered with this new stage. They are at risk for social isolation and mood disturbance.

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