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We must remember that patients with chronic chest diseases like emphysema, chronic bronchitis, live their life in a low exercise state, their ability to exercise is reduced, any form of exercise will result in that patient becoming breathless. This is normal for them. It is a complex condition with ongoing specialist personnel managing that patient's medications and symptoms. There are times when we will come across a COPD patient who we believe will require oxygen administration. We need to be guided by pulse oximetry in this case. It is normal for a COPD patient to have a SpO2 reading of between 88% and 92%. In this case, we would not administer oxygen to that patient, however, if this SpO2 was less than 88%, we need to consider titrating oxygen to the patient's response. But please remember that we are never going to get this patient completely out of breath. A symptom of their chronic condition is breathlessness.

If a patient is severely hypoxic, cyanosed, and at the point of collapse, that patient requires oxygen, and it should be administered as appropriate. A patient who is in respiratory arrest should be administered oxygen and artificial ventilation, just the same as any other patient. If when dealing with a COPD patient and administering oxygen, the patient's condition worsens, then that will may well be an indication for us to withhold the oxygen. The theoretical principle of knocking out the patient's hypoxic drive, which is what these patients become dependent on, is not something that will happen immediately, but it is a slow process. We will often see a deterioration of the patient's condition before they go into a respiratory arrest.