No medical community has come forward to spread awareness on this captivating yet unscientific business

The popularity of packaged air began around four years ago when a Canadian company launched ‘canned air’ for people in China when air pollution in many cities became alarmingly high. The newer addition — oxygen-bar — a recreational parlour or cafe which serves ‘pure oxygen’ is becoming a more attractive destination, particularly in cities with dangerous levels of air pollution. At times, the oxygen comes in different scented flavours.

In cities with highly polluted air, the business of ‘canned oxygen’ or ‘oxygen-bar’ is flourishing. The recent launch of such a recreational oxygen parlour in Delhi amidst the city’s infamously bad air condition has caught significant media attention. But how safe are they and are any benefits at all?

First, do we really need this extra oxygen? The simplest answer is no. Unlike conventional oxygen therapies used in respiratory conditions that is administered for a short or long period in hospital or at home, people take oxygen for an ultra-short period in these bars (30 minutes or less). As per the standard clinical procedure, oxygen supplementation can be administered only in case of hypoxemia (lowering of oxygen saturation in the arterial blood below 95%) and it does not have any consistent beneficial effect on non-hypoxemic patients.

Placebo, at best

It must and should be remembered that the oxygen level does not alter in the air even when the pollution level is high. The same applies to our health — oxygen saturation in blood remains unchanged in healthy people in normal conditions, and such recreational oxygen cannot provide any health improvement. It can at best have a placebo effect. Though users and proponents of purified oxygen claim several benefits such as relieving stress, headache and migraine, and help in achieving better energy and mood, there is no clinical evidence available so far in support of the beneficial effects of recreational oxygen use.

Most importantly, the use of scented oxygen might not be safe. To add scent to oxygen, the oxygen is bubbled through a liquid containing scented additives or aroma oil. Users will seldom know the properties of the oils or the components of the additives used. Scented oxygen can be harmful to people, particularly to those with allergies and lung diseases. Fragrant materials very often contain aromatic hydrocarbons, many of which are potential allergens and can trigger asthma and allergic symptoms.

Moreover, the aromatistion of oxygen generates ultrafine droplets of essential oils which, when inhaled with oxygen, get deposited in the lungs and accumulate in the alveoli leading to a respiratory condition known as “lipoid pneumonia”. In this condition, deposited oil droplets can cause severe inflammation, damage alveolar septa (thin single cell lining between two adjacent alveoli) and interstitium (the area between an alveolus and its adjacent capillary) and lead to fibrosis. Long-term exposure to such exogenous oil substances may cause chronic lipoid pneumonia in which the patients remain asymptomatic and are often diagnosed at a very late-stage, and that too, incidentally, due to other illnesses. Among people with a lung condition, even a short-term acute exposure to such exogenous fragrance or oils can be life-threatening.

It must be borne in mind that oxygen-bars are sole-proprietorship ventures and are not legalised to administer oxygen for therapeutic purposes. These bars are not endorsed by local or federal healthcare systems and are not obliged to follow clinical bylaws, and thus cannot be held liable for any unwarranted health effect or an acute medical condition that occurs in the bars. Moreover, there are no statutory warnings or guidelines available at these bars about the potential adverse effects, particularly applicable to vulnerable population such as children, aged and person with allergies or lung conditions.

Captivating yet unscientific

It is unfortunate that no medical community has come forward to spread awareness among people for this increasingly captivating yet unscientific business with no known or established clinical benefit. It definitely calls for serious vigilance by the clinicians and policy makers to ensure the safety issues associated with recreational oxygen use, particularly flavoured oxygen in such bars, parlours and spas.

The writer is a European Respiratory Society Research Fellow at ISGlobal, Barcelona, Spain, and associate member of the Royal Society for Public Health, United Kingdom.

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