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Hospital admissions for exacerbations are major events in the lives of people with COPD. The prognosis for such patients is grim. Around one in seven will die within 3 months of admission, and fewer than half will still be alive at 5 years.1 ,2 The symptoms they experience are frightening and unpleasant,3 their quality of life is reduced4 and the restriction in their physical activity, which may persist for weeks after the onset of symptoms, increases the risk that they will become housebound.5 In comparison with other medical emergencies, such as myocardial infarction and stroke, progress in improving the management of COPD exacerbations has been depressingly slow. Arguably, the last major advance was the introduction of non-invasive ventilation, which took place sometime in the latter part of the last century. Against this backdrop, it is vital that, as a clinical and research community, we should tenaciously pursue all opportunities to improve the experience for these patients. In doing this, we must reflect critically on our existing practice and the pain and burdens it may present for those who endure it. In this issue of Thorax, McKeever et al6 do just this, by questioning the need for an investigation that many of us would consider almost sacrilegious to omit: the arterial blood gas.
Learning and refining the technique of arterial blood sampling is a rite of passage for medical students, junior doctors and increasingly other healthcare professionals. Evidence of their efforts is perhaps most conspicuous among the inpatient COPD population, where masses of haphazardly taped cotton-wool balls adorn the increasingly purpuric wrists of these unfortunate individuals. As McKeever et al have observed, the pain associated with arterial blood …