Effect of hypobaric hypoxia on blood gases in patients with restrictive lung disease

Christensen, Carl C.; Ryg, Morten; Refvem, O; Skjønsberg, Ole Henning

doi:10.1183/09031936.02.00222302

Cited by 42 publications

(35 citation statements)

References 17 publications

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“…Only two studies have examined changes in arterial oxygenation with simulated ascent to high altitude. SECCOMBE et al [74] exposed 15 patients with unspecified types of ILD to an FI,O 2 of 0.15 (corresponding to a simulated altitude of 2,438 m) and found that the Pa,O 2 fell from a sea-level average of 11¡0.9 kPa (84¡6.8 mmHg) to a simulated high-altitude average of 6.8¡1.0 kPa (51¡7.5 mmHg) at rest and 5.5¡0.7 kPa (41¡5 mmHg) after walking 50 m. CHRISTENSEN et al [251] studied 17 patients with a heterogeneous group of restrictive disorders and found that exposure to a simulated altitude of 2,438 m caused the Pa,O 2 to fall from a sealevel average of 10¡1.6 kPa (78¡12 mmHg) to 6.5¡1.1 kPa (49¡8 mmHg) at rest and 5.1¡0.9 kPa (38¡6.8 mmHg) following 20-W exercise. They also found that supplemental oxygen at 2 L?min -1 at rest and 4 L?min -1 with exercise was sufficient to maintain Pa,O 2 .6.7 kPa (50 mmHg).…”

Section: Interstitial Lung Diseasesmentioning

confidence: 97%

“…They also found that supplemental oxygen at 2 L?min -1 at rest and 4 L?min -1 with exercise was sufficient to maintain Pa,O 2 .6.7 kPa (50 mmHg). In terms of whether the patients developed symptoms as a result of their hypoxaemia, SECCOMBE et al [74] reported a statistically significant increase in the Borg dyspnoea score in their subject group, while CHRISTENSEN et al [251] only noted that two subjects terminated their exercise study after only 2 min due to dyspnoea. CHRISTENSEN et al [251] provide a regression equation, which takes into account the sea-level Pa,O 2 and TLC (measured as % pred).…”

Section: Interstitial Lung Diseasesmentioning

confidence: 99%

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Travel to high altitude with pre-existing lung disease

Luks

Swenson²

2007

Eur Respir J

107

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The pathophysiology of high-altitude illnesses has been well studied in normal individuals, but little is known about the risks of high-altitude travel in patients with pre-existing lung disease. Although it would seem self-evident that any patient with lung disease might not do well at high altitude, the type and severity of disease will determine the likelihood of difficulty in a high-altitude environment. The present review examines whether these individuals are at risk of developing one of the main forms of acute or chronic high-altitude illness and whether the underlying lung disease itself will get worse at high elevations. Several groups of pulmonary disorders are considered, including obstructive, restrictive, vascular, control of ventilation, pleural and neuromuscular diseases. Attempts will be made to classify the risks faced by each of these groups at high altitude and to provide recommendations regarding evaluation prior to high-altitude travel, advice for or against taking such excursions, and effective prophylactic measures.

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Section: Interstitial Lung Diseasesmentioning

confidence: 97%

Section: Interstitial Lung Diseasesmentioning

confidence: 99%

Travel to high altitude with pre-existing lung disease

Luks

Swenson²

2007

Eur Respir J

107

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“…The large number of UK centres that took part and of patients recruited suggests, as previously noted, that potential problems associated with respiratory disease and air travel are well recognised [8], as is the need for more substantial evidence on which to base future recommendations. With a few exceptions [9][10][11][12], previous studies aimed at determining risk in adult passengers have examined small numbers of patients with COPD [13][14][15][16][17][18][19][20][21][22] in the acute setting. They have largely excluded comorbidity and studied stable patients.…”

Section: Discussionmentioning

confidence: 99%

Is air travel safe for those with lung disease?

Coker¹,

Shiner²,

Partridge³

2007

Eur Respir J

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Airlines commonly report respiratory in-flight emergencies; flight outcomes have not been examined prospectively in large numbers of respiratory patients. The current authors conducted a prospective, observational study of flight outcomes in this group.UK respiratory specialists were invited to recruit patients planning air travel. Centres undertook their usual pre-flight assessment. Within 2 weeks of returning, patients completed a questionnaire documenting symptoms, in-flight oxygen use and unscheduled healthcare use.In total, 616 patients were recruited. Of these, 500 (81%) returned questionnaires. The most common diagnoses were airway (54%) and diffuse parenchymal lung disease (23%). In total, 12 patients died, seven before flying and five within 1 month. Pre-flight assessment included oximetry (96%), spirometry (95%), hypoxic challenge (45%) and walk test (10%). Of the patients, 11% did not fly. In those who flew, unscheduled respiratory healthcare use increased from 9% in the 4 weeks prior to travel to 19% in the 4 weeks after travel. However, when compared with selfreported data during the preceding year, medical consultations increased by just 2%.In patients flying after careful respiratory specialist assessment, commercial air travel appears generally safe.

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“…OADES et al [24] have assessed flight fitness in children with cystic fibrosis and found the hypoxic challenge to be a good predictor of which patients were at risk of significant desaturation during flight. CHRISTENSEN et al [25] have studied patients with restrictive lung disease, from a variety of different causes, in a hypobaric chamber and have demonstrated that these patients may become hypoxic when exposed to 2,438 metres of simulated altitude.…”

Section: Methods Of Predicting Hypoxiamentioning

confidence: 99%

Problems of air travel for patients with lung disease: clinical criteria and regulations

Robson

2006

Breathe

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Key pointsCommercial aircraft have a hypoxic environment, equivalent to an altitude of 2,438 m (8,000 ft) above sea level.Normal subjects and the majority of respiratory patients can tolerate this without symptoms. In practice, medical diversions for respiratory problems are very rare.The tendency of individual patients to become hypoxic in these conditions cannot be predicted with accuracy from sea-level oxygen saturation or spirometry.Hypoxic challenge may be used to simulate the inflight environment, to predict hypoxaemia and to assess the effectiveness of inflight oxygen.Most airlines, with adequate warning, can provide oxygen at 2 or 4 litres per minute for respiratory patients.While it may be possible to predict hypoxia during flight, there are no means of predicting symptoms or actual risk of harm during air travel.Educational aimsTo identify the potential problems that patients with chronic respiratory conditions may encounter during air travel.To recognise that guidelines have been developed from a number of sources to assist doctors involved in assessing a patient who is considering air travel.To make clinicians aware of the different methods of hypoxic challenge that have been developed to help with the clinical assessment of patients.To highlight that many patients with chronic lung disease are capable of air travel without developing significant hypoxia, but to raise awareness about which patients are likely to be at risk.To discuss the potential difficulties that may arise for the patient when they are arranging inflight oxygen.SummaryDoctors are frequently asked by patients with chronic lung disease if they are fit to fly. As commercial flights are not pressurised to sea level, there is a reduction in partial pressure of oxygen (PO2), which may result in significant hypoxia in otherwise asymptomatic patients.A number of different assessment methods have been developed to assess flight fitness and several professional organisations have developed guidelines to help doctors give informed advice.Patients who become significantly hypoxic during a flight assessment may still be able to travel with supplemental oxygen. However, the provision of supplemental oxygen is dependent on individual airline policy and considerable variations in policy have been recorded.This review aims to give a brief overview of air travel for patients with lung disease, including physiology, guidelines, assessing fitness to fly and oxygen supplementation.

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Effect of hypobaric hypoxia on blood gases in patients with restrictive lung disease

Cited by 42 publications

References 17 publications

Travel to high altitude with pre-existing lung disease

Travel to high altitude with pre-existing lung disease

Is air travel safe for those with lung disease?

Problems of air travel for patients with lung disease: clinical criteria and regulations

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