COPD patients can benefit from intermittent hypoxia training (IHHT/IHT). While it cannot cure the disease, this gentle approach can significantly improve patient well-being.
Behind the four letters COPD lies Chronic Obstructive Pulmonary Disease – a chronic lung condition characterized by permanently narrowed airways.
Many COPD patients already have an oxygen saturation (SpO₂) below 95 percent at rest, with some even just under 90 percent. At first glance, it may seem contradictory to expose such patients to additional hypoxia. After all, they are already “under-supplied.” Moreover, patients in advanced stages often require continuous oxygen therapy.
The crucial difference: Intermittent Hypoxia Training (IHHT/IHT) is not a permanent undersupply, but rather a temporary lack of oxygen followed by reoxygenation. This alternating stimulus activates adaptive processes that may positively influence the course of the disease.
IHHT/IHT Effects in COPD
COPD has no cure to date, and IHHT/IHT cannot heal it either. However, IHHT/IHT can beneficially affect the disease process as a whole, thereby improving quality of life. Patients often report noticeably more energy and resilience in daily life after IHHT/IHT.
Many benefit from bronchodilation. Gas exchange between alveoli and blood is optimized, inflammatory processes are reduced, and mitochondria are trained to produce more energy with less oxygen. This increases tolerance to hypoxia, which in turn eases the burden of shortness of breath.
COPD Studies and IHHT/IHT
Most COPD studies involving IHHT/IHT have been performed with cycles of hypoxia and normoxia. The results strongly support its application in COPD. Only later was training with hyperoxia introduced (Intermittent Hypoxia–Hyperoxia Training, IHHT).
In most cases, the hyperoxia phase used 30% oxygen in the breathing mixture for 3–5 minutes. IHHT also produced favorable outcomes.
Most researchers regard oxygen enrichment to 30% as mild hyperoxia, sufficient for reoxygenation after hypoxia. However, every increase in oxygen also generates oxidative stress – already a central issue in COPD. So far, comparative studies between reoxygenation with normoxia (room air) versus hyperoxia are lacking.
IHHT/IHT with Normoxia vs. Hyperoxia in COPD
COPD patients often perceive the alternation of hypoxia and hyperoxia as more pleasant than hypoxia and normoxia.
The late Prof. Tetiana Serebrovska (1947–2021) illustrated this with the following example: In a study of children with asthma, the long-term effects of oxygen surplus versus deficiency were observed.
- Children who inhaled oxygen-enriched air felt better during and immediately after treatment: rosy cheeks, more active behavior.
- Children exposed to reduced oxygen appeared pale and tired right after treatment.
Yet in the long term, the hypoxia-treated children improved more. Between sessions they became livelier, while the oxygen-enriched group weakened and lost vitality.
This shows that short-term well-being after IHHT is not always indicative of its long-term benefit.
Given that COPD is characterized by oxidative stress, I would be cautious with hyperoxia at the beginning, especially if oxygen enrichment exceeds 30%. In such cases, alternating hypoxia with normoxia is preferable.
Practical Aspects of IHHT/IHT in COPD
In COPD patients, a large drop in SpO₂ is not the primary goal. Clinical experience shows that lowering SpO₂ to 85–90% during hypoxia is sufficient. For patients already at 90% at rest, a reduction of just 2–3 percentage points (to around 87%) may be enough.
The duration and depth of hypoxia phases should always be adapted to the patient’s condition. In my practical handbook, I provide detailed settings for patients with chronic diseases.
If IHHT is applied, the oxygen concentration during the hyperoxia phase should be set at 30% for 2–3 minutes.
Experience and studies show that resting SpO₂ values improve measurably after 15–20 sessions. These benefits can only be maintained with regular hypoxia sessions. Because many patients feel the positive effects so clearly, most are willing to continue IHHT/IHT once or twice per week.
IHHT/IHT and Contraindications
Most guidelines list advanced COPD (stage 3) as a contraindication for IHHT/IHT. However, clinical practice shows that even at this stage, improvements are possible. Complications such as hypertension, metabolic dysregulation, and vascular damage can also be positively influenced by IHHT/IHT.
Therefore, I regard IHHT/IHT in stage 3 COPD not as an absolute, but as a relative contraindication. This means that experienced IHHT/IHT therapists may still treat patients at this stage.
More compact knowledge on the effects and applications of Intermittent Hypoxia Training (IHHT/IHT) can be found in my online modules: https://ecampus.hccacademy.de/s/hccacademy/en
September 24, 2025 – Dr. Egor Egorov, MD, Hypoxia Expert
