Those who presented with a low po2 and/or hypercapnia to guide later formal assessment for ltot. 4 to 6 weeks' follow-up should include consideration of ltot assessment - not before, as the patient needs to be clinically stable. [6] long-term oxygen therapy[7] once this is started, ltot is likely to be lifelong. viagra without a doctor prescription It is usually given over a minimum of 15 hours a day, including overnight when arterial hypoxaemia worsens during sleep (some advocate 18 or even 24 hours a day). Assess the need for oxygen therapy in people with any of the following: very severe airflow obstruction - forced expiratory volume in one second (fev1) less than 30% predicted. viagra wholesale Cyanosis. buy viagra without prescription Polycythaemia. Peripheral oedema. viagra pills for sale uk Raised jugular venous pressure. buy female viagra in india Oxygen saturation 92% or below when breathing air. buy viagra Consider assessment for people with severe airflow obstruction (fev1 30-49% predicted). Assess by measuring abgs on two occasions at least 3 weeks apart in people with confirmed stable copd who are receiving optimum medical management. best price on viagra canada Obtaining abgs in the community can be difficult and may require a visit to the local hospital or involvement of the specialist respiratory nurse. average age for viagra users Offer ltot to people with pao2 less than 7. 3 kpa when stable, or greater than 7. where to buy cials and viagra online 3 and less than 8 kpa when stable and with secondary polycythaemia, peripheral oedema, nocturnal hypoxaemia or pulmonary hypertension. Be aware that inappropriate oxygen therapy in people with copd may cause respiratory depression. All healthcare settings should have a pulse oximeter to ensure all people needing ltot are identified and to review people receiving ltot at least once a year. People receiving ltot should breathe supplemental oxygen for at least 15 hours a day. If they smoke, warn them about the risk of fire and explosion. Use oxygen concentrators to provide the fixed supply for ltot at home. Refer people who are hypercapnic or acidotic on ltot to a specialist centre for consideration of long-term noninvasive ventilation (niv). Niv should be used as the treatment of choice f. order viagra