Air travel and chronic obstructive pulmonary disease: a new algorithm for pre-flight evaluation

Abstract

BackgroundThe reduced pressure in the aircraft cabin may cause significant hypoxaemia and respiratory distress in patients with chronic obstructive pulmonary disease (COPD). Simple and reliable methods for predicting the need for supplemental oxygen during air travel have been requested. Objective To construct a pre-flight evaluation algorithm for patients with COPD. Methods In this prospective, cross-sectional study of 100 patients with COPD referred to hypoxia-altitude simulation test (HAST), sea level pulse oximetry at rest (SpO 2 SL ) and exercise desaturation (SpO 2 6MWT ) were used to evaluate whether the patient is fit to fly without further assessment, needs further evaluation with HAST or should receive in-flight supplemental oxygen without further evaluation. HAST was used as the reference method. Results An algorithm was constructed using a combination of SpO 2 SL and SpO 2 6MWT . Categories for SpO 2 SL were >95%, 92e95% and <92%, the cut-off value for SpO 2 6MWT was calculated as 84%. Arterial oxygen pressure (PaO 2 HAST ) <6.6 kPa was the criterion for recommending supplemental oxygen. This algorithm had a sensitivity of 100% and a specificity of 80% when tested prospectively on an independent sample of patients with COPD (n¼50). Patients with SpO 2 SL >95% combined with SpO 2 6MWT $84% may travel by air without further assessment. In-flight supplemental oxygen is recommended if SpO 2 SL ¼92e95% combined with SpO 2 6MWT <84% or if SpO 2 SL <92%. Otherwise, HAST should be performed. Conclusions The presented algorithm is simple and appears to be a reliable tool for pre-flight evaluation of patients with COPD.

Chronic Obstructive Pulmonary Disease: Official diagnosis and treatment guidelines of the Czech Pneumological and Phthisiological Society; a novel phenotypic approach to COPD with patient-oriented care

“…Oxygen therapy should be considered in all individuals with either SpO 2 <92% at rest or SpO 2 <84% during 6MWT (ref. 108 ). The use of long-term home-based non-invasive ventilation (NIV) is the method of choice in stable COPD patients with chronic hypercapnic respiratory failure, i.e.…”

COPD and air travel: does hypoxia-altitude simulation testing predict in-flight respiratory symptoms?

“…1) [4]. The inclusion criteria were moderate to very severe COPD [13] and air travel without supplemental oxygen performed within the past 2 years.…”

“…In-flight hypoxaemia has proven difficult to predict; neither sea-level arterial oxygen levels nor spirometric values alone seem to be reliable tools for this purpose [1]. In a recent study, we have shown that a combination of arterial oxygen saturation measured by pulse oximetry (SpO 2 ) at rest and SpO 2 during exercise at sea level predicts in-flight hypoxaemia with high sensitivity and specificity in patients with chronic obstructive pulmonary disease (COPD) [4]. Some patients, however, are in need of more advanced pre-flight testing using a hypoxia-altitude simulation test (HAST), breathing a gas mixture with 15.1% oxygen, corresponding to an aircraft cabin altitude of 8000 feet (2438 m) [5][6][7].…”

Primary Care of the Patient with Asthma

“…The latter groups should undergo specialty consultation and, perhaps, a hypoxic challenge test before air travel. 75 Patients with a resting oxygen requirement of greater than 4 L/min should not travel by air. 76 SUMMARY Asthma occurs in adults, even at an advanced age, particularly with certain occupations, tobacco smoke exposure, female sex, obesity, or recent upper respiratory disease.…”