Interstitial lung disease, early pulmonary vascular disease and a good deal of COPD all sit at 96 per cent on the finger at rest and desaturate the moment the patient stands up and walks. If the only oximetry recorded is at rest, the finding that would have changed management is the one you did not look for.
Walk them. A corridor and a stopwatch is enough if a formal six-minute walk test is not available: record the distance, the lowest saturation reached, the heart rate, and how breathless they were at the end. A fall to 88 per cent or below on exertion is a finding, whatever the resting value, and it should prompt reassessment rather than reassurance.
Repeat it at review with the same corridor and the same protocol, because the change over time is worth more than any single number. And write down what the patient was carrying, holding, or being assisted with, because that is the variable that silently changes between visits.
- Record oxygen saturation on exertion, not only at rest, in any suspected interstitial or vascular lung disease.
- Use a fixed corridor and a stopwatch when a formal six-minute walk test is unavailable.
- Note distance, lowest saturation, heart rate and breathlessness score together.
- Treat a fall to 88 per cent or below on exertion as a finding regardless of the resting value.
- Repeat with the identical protocol so serial comparison means something.
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