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What is the difference between hyperbaric oxygen and ozone therapy?


Hyperbaric Oxygen Therapy (HBOT) involves breathing in pure oxygen under increased pressure in a special pressurised chambers. This form of therapy is available on the NHS for specific medical condition, e.g for radiotherapy side effects. It has also been promoted as a complementary therapy e.g for chronic fatigue and post-viral illnesses. 


Most oxygen carried in the blood is bound to haemoglobin with only a small percentage of oxygen dissolved in the plasma (the liquid part of the blood). It is this proportion of oxygen that can be increased if oxygen is inhaled at high pressure. Breathing oxygen at high pressure thus increases the blood oxygen-carrying capacity by allowing the plasma to carry more oxygen. The proportion carried in plasma can be sufficient on its own to support tissues without a contribution from haemoglobin. As the oxygen is in solution, it can reach physically obstructed areas where red blood cells cannot pass. This enables tissue oxygenation even with impaired haemoglobin oxygen carriage, such as in carbon monoxide poisoning and severe anaemia. This can create an environment that is more conducive to healing such as in trauma, severe infections, radiotherapy damage to blood vessels and skin grafts.  


Extra oxygen in the blood however causes vasoconstriction (narrowing of blood easels) but this is more than compensated for by increased plasma oxygen carriage with the net result in favour of more tissue oxygenation. Such vasoconstriction does however reduce tissue swelling, a desirable effect in crush injuries and burns.


HBOT also has an effect on fighting infections, particularly those caused by bacteria that prefers low-oxygen environments (anaerobic bacteria). Oxygen also facilitates an oxygen-dependent defence system by which the white cells kill bacteria. 


In summary, HBOT has complex effects on immunity, oxygen transport and haemodynamics. The positive therapeutic effects come from a reduction in hypoxia and oedema, enabling normal host responses to infection and ischaemia.


From the above description you can see some similarities between ozone therapy and HBOT, in particular the improvement in tissue oxygenation and the effect on the immune system. However there are some important differences in the underlying mechanisms of action. For example: HBOT improves tissue oxygenation by directly providing more oxygen to the tissues from breathing 100% oxygen at high pressure. This effect does not persist long after the end of of the session, a reason why HBOT usually needs prolonged daily or even twice daily sessions. This is because oxygen is rapidly utilised by the body once the external source of oxygen is interrupted. Ozone therapy on the other hand improves delivery of oxygen to the tissue by a completely different mechanism: ozone increases the level of a specific enzyme in red blood cells called 2,3-diphosphoglycerate (2,3-DPG) which helps the red cells to offload more oxygen to tissues. The levels of 2,3-DPG do not fall immediately following cessation of the ozone session thus allowing a prolonged and a more natural increase in tissue oxygenation. 

Secondly, the effect on the immune system is more complex with ozone therapy with signalising cascades put in motion creating a whole host of effects on the immune cells, including inducing the cytokines system. Ozone also has a direct toxic effect on micro-organisms. 


It is also important to remember that ozone therapy involves giving at least 95% oxygen in addition to ozone. The oxygen simply works as a career to deliver ozone to interact with the blood, or when locally applied such as in the treatment of ulcers, oxygen and ozone work together to improve tissue oxygenation (both) and sterilising the ulcer (ozone only). 


In summary: Ozone and HBOT share some similarities with ozone having more modes of action and more sustained effect. Ozone is also delivered as a mixture with oxygen but most of the beneficial actions are mediated by the ozone.  

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