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In-Reply-To: <000e01bf88d6$84d51840$7b518cd4@default> Yes, I agree with Judith's view. Chronic airways disease is a slow melting of lung tissue, and does not present acutely - what you get are acute bacterial or viral exacerbations, and despite Moore-Gillon's letter to the Lancet in 1979 that started the row when he told of patients arriving at hospital comatose because their oxygen drive had been compromised, it really isn't a problem clinically - patient has oxygen, becomes sleepier and more lethargic so you take the mask off again - they wake up. Then you know they are using oxygen drive. More people suffer chronic hypoxia prehospital and in hospital because of fears about a tiny group of patients (who are likely to die shortly anyway) than from any other single cause. Once they get to A&E a blood gas analysis will rapidly settle the matter. Best wishes, Rowley Cottingham [log in to unmask] %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%