There is good evidence that under- or overuse of oxygen in patients with underlying respiratory disease can result in complications and poor clinical outcome.1 Oxygen is a drug as described in the British National Formulary and should be prescribed and dispensed as any drug. Previous audit has shown that oxygen prescription and dispensing are poor in clinical areas.2 With the arrival of acute oxygen guidelines from the British Thoracic Society imminent, we aimed to identify and quantify this problem in …