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Pezzuto A, Trabalza Marinucci B, Ricci A, Ciccozzi M, Tonini G, D'Ascanio M, Guerrieri G, Chianese M, Castelli S, Rendina EA. Predictors of respiratory failure after thoracic surgery: a retrospective cohort study with comparison between lobar and sub-lobar resection. J Int Med Res 2022; 50:3000605221094531. [PMID: 35768901 PMCID: PMC9251996 DOI: 10.1177/03000605221094531] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Only approximately 15% of patients with lung cancer are suitable for surgery and clinical postoperative outcomes vary. The aim of this study was to investigate variables associated with post-surgery respiratory failure in this patient cohort. Methods Patients who underwent surgery for lung cancer were retrospectively studied for respiratory function. All patients had undergone lung resection by a mini-thoracotomy approach. The study population was divided into two subgroups for comparison: lobectomy group, who underwent lobar resection; and sub-lobar resection group. Results A total of 85 patients were included, with a prevalence of lung cancer stage IA and adenocarcinoma histotype. Lobectomy (versus sub-lobar resection), the presence of chronic obstructive pulmonary disease (COPD), and a COPD assessment test (CAT) score >10, were all associated with an increased risk of respiratory failure. The partial pressure of arterial oxygen decreased more in the lobectomy group than in the sub-lobar resection group following surgery, with a significant postoperative between-group difference in values. Postoperative CAT scores were also better in the sub-lobar resection group. Conclusions Post-surgical variations in functional parameters were greater in the group treated by lobectomy. COPD, high CAT score and surgery type were associated with postoperative development of respiratory failure.
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Affiliation(s)
- Aldo Pezzuto
- Department of Cardiovascular and Respiratory Sciences, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | | | - Alberto Ricci
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Massimo Ciccozzi
- Department of Epidemiology, Campus Bio-Medico University, Rome, Italy
| | - Giuseppe Tonini
- Department of Oncology, Campus Bio-Medico University, Rome, Italy
| | - Michela D'Ascanio
- Department of Cardiovascular and Respiratory Sciences, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Giulio Guerrieri
- Department of Cardiovascular and Respiratory Sciences, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Maria Chianese
- Department of Cardiovascular and Respiratory Sciences, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Silvia Castelli
- Department of Cardiovascular and Respiratory Sciences, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Erino Angelo Rendina
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Holthof K, Bridevaux PO, Frésard I. Underlying lung disease and exposure to terrestrial moderate and high altitude: personalised risk assessment. BMC Pulm Med 2022; 22:187. [PMID: 35534855 PMCID: PMC9088024 DOI: 10.1186/s12890-022-01979-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
Once reserved for the fittest, worldwide altitude travel has become increasingly accessible for ageing and less fit people. As a result, more and more individuals with varying degrees of respiratory conditions wish to travel to altitude destinations. Exposure to a hypobaric hypoxic environment at altitude challenges the human body and leads to a series of physiological adaptive mechanisms. These changes, as well as general altitude related risks have been well described in healthy individuals. However, limited data are available on the risks faced by patients with pre-existing lung disease. A comprehensive literature search was conducted. First, we aimed in this review to evaluate health risks of moderate and high terrestrial altitude travel by patients with pre-existing lung disease, including chronic obstructive pulmonary disease, sleep apnoea syndrome, asthma, bullous or cystic lung disease, pulmonary hypertension and interstitial lung disease. Second, we seek to summarise for each underlying lung disease, a personalized pre-travel assessment as well as measures to prevent, monitor and mitigate worsening of underlying respiratory disease during travel.
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Affiliation(s)
- Kirsten Holthof
- Service de pneumologie, Centre Hospitalier du Valais Romand, Avenue du Grand-Champsec 80, 1950, Sion, Switzerland
| | - Pierre-Olivier Bridevaux
- Service de pneumologie, Centre Hospitalier du Valais Romand, Avenue du Grand-Champsec 80, 1950, Sion, Switzerland.,Service de pneumologie, Hôpitaux universitaires de Genève, 1211, Geneva 14, Switzerland.,Geneva Medical School, University of Geneva, Geneva, Switzerland
| | - Isabelle Frésard
- Service de pneumologie, Centre Hospitalier du Valais Romand, Avenue du Grand-Champsec 80, 1950, Sion, Switzerland.
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Coker RK, Armstrong A, Church AC, Holmes S, Naylor J, Pike K, Saunders P, Spurling KJ, Vaughn P. BTS Clinical Statement on air travel for passengers with respiratory disease. Thorax 2022; 77:329-350. [PMID: 35228307 PMCID: PMC8938676 DOI: 10.1136/thoraxjnl-2021-218110] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robina Kate Coker
- Respiratory Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Alison Armstrong
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | | | - Katharine Pike
- Department of Paediatric Respiratory Medicine, Bristol Royal Hospital for Children, Bristol, UK
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Effects of Altitude on Chronic Obstructive Pulmonary Disease Patients: Risks and Care. Life (Basel) 2021; 11:life11080798. [PMID: 34440542 PMCID: PMC8401125 DOI: 10.3390/life11080798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/28/2021] [Accepted: 08/05/2021] [Indexed: 02/02/2023] Open
Abstract
Air travel and altitude stays have become increasingly frequent within the overall population but also in patients suffering from chronic obstructive pulmonary disease (COPD), which is the most common respiratory disease worldwide. While altitude is well tolerated by most individuals, COPD patients are exposed to some serious complications, that could be life-threatening. COPD patients present not only a respiratory illness but also frequent comorbidities. Beyond oxygen desaturation, it also affects respiratory mechanics, and those patients are at high risk to decompensate a cardiac condition, pulmonary hypertension, or a sleep disorder. Recently, there has been considerable progress in the management of this disease. Nocturnal oxygen therapy, inhaled medications, corticosteroids, inspiratory muscle training, and pulmonary rehabilitation are practical tools that must be developed in the comprehensive care of those patients so as to enable them to afford altitude stays.
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Dzhalilova D, Makarova O. Differences in Tolerance to Hypoxia: Physiological, Biochemical, and Molecular-Biological Characteristics. Biomedicines 2020; 8:E428. [PMID: 33080959 PMCID: PMC7603118 DOI: 10.3390/biomedicines8100428] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
Hypoxia plays an important role in the development of many infectious, inflammatory, and tumor diseases. The predisposition to such disorders is mostly provided by differences in basic tolerance to oxygen deficiency, which we discuss in this review. Except the direct exposure of different-severity hypoxia in decompression chambers or in highland conditions, there are no alternative methods for determining organism tolerance. Due to the variability of the detection methods, differences in many parameters between tolerant and susceptible organisms are still not well-characterized, but some of them can serve as biomarkers of susceptibility to hypoxia. At the moment, several potential biomarkers in conditions after hypoxic exposure have been identified both in experimental animals and humans. The main potential biomarkers are Hypoxia-Inducible Factor (HIF)-1, Heat-Shock Protein 70 (HSP70), and NO. Due to the different mechanisms of various high-altitude diseases, biomarkers may not be highly specific and universal. Therefore, it is extremely important to conduct research on hypoxia susceptibility biomarkers. Moreover, it is important to develop a method for the evaluation of organisms' basic hypoxia tolerance without the necessity of any oxygen deficiency exposure. This can contribute to new personalized medicine approaches' development for diagnostics and the treatment of inflammatory and tumor diseases, taking into account hypoxia tolerance differences.
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Affiliation(s)
- Dzhuliia Dzhalilova
- Department of Immunomorphology of Inflammation, Federal State Budgetary Institution ‘Research Institute of Human Morphology’, Moscow 117418, Russia;
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Choosing an Adequate Test to Determine Fitness for Air Travel in Obese Individuals. Chest 2019; 156:926-932. [PMID: 31419402 DOI: 10.1016/j.chest.2019.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/03/2019] [Accepted: 07/20/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Air travel is physically demanding and, because obesity is rising, physicians increasingly need to assess whether such patients can fly safely. Our aim was to compare the diagnostic accuracy of two routinely used exercise tests, 50-m walk test and 6-min walk test, and hypoxic challenge testing (HCT) in obese individuals. We further explored the diagnostic potential of perceived dyspnea as measured with the Borg scale because this is often recorded subsequent to walking tests. METHODS In this prospective study, we examined 21 obese participants (10 women, age 51 ± 15 [mean ± SD], BMI 36 ± 5 kg/m2). The most prevalent comorbidity was COPD (n = 11). The reference standard for in-flight hypoxia, defined as oxygen saturation below 90%, was established in an altitude chamber. Diagnostic accuracy of each index test was estimated by area under the receiver operating characteristic curve (AUC). RESULTS Of the 21 participants, 13 (9 with COPD) were identified with in-flight hypoxia. HCT was the only test separating the reference groups significantly with AUC 0.87 (95% CI, 0.62-0.96). Neither of the walking tests predicted noticeably above chance level: 50 m walk test had an AUC of 0.63 (0.36-0.84) and 6MWT had an AUC of 0.64 (0.35-0.86). We further observed good prognostic ability of subjective dyspnea assessment when recorded after 6MWT with an AUC of 0.80 (0.55-0.93). CONCLUSIONS In-flight hypoxia in obese individuals can be predicted by HCT but not by simple walking tests.
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Ergan B, Akgun M, Pacilli AMG, Nava S. Should I stay or should I go? COPD and air travel. Eur Respir Rev 2018; 27:27/148/180030. [PMID: 29898904 PMCID: PMC9489124 DOI: 10.1183/16000617.0030-2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/30/2018] [Indexed: 11/26/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a challenging respiratory problem throughout the world. Although survival is prolonged with new therapies and better management, the magnitude of the burden resulting from moderate-to-severe disease is increasing. One of the major aims of the disease management is to try to break the vicious cycle of patients being homebound and to promote an active lifestyle. A fundamental component of active daily life is, of course, travelling. Today, the world is getting smaller with the option of travelling by air. Air travel is usually the most preferred choice as it is easy, time saving, and relatively inexpensive. Although it is a safe choice for many passengers, the environment inside the aeroplane may sometimes have adverse effects on health. Hypobaric hypoxaemia due to cabin altitude may cause health risks in COPD patients who have limited cardiopulmonary reserve. Addressing the potential risks of air travel, promoting proactive strategies including pre-flight assessment, and education of COPD patients about the “fitness to fly” concept are essential. Thus, in this narrative review, we evaluated the current evidence for potential risks of air travel in COPD and tried to give a perspective for how to plan safe air travel for COPD patients. COPD patients should be informed about the “fitness to fly” concept and patients with moderate-to-severe disease need to be assessed with clinical and functional parameters for possible risk factors for in-flight hypoxaemia before flyinghttp://ow.ly/Yd4A30k41Hq
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Affiliation(s)
- Begum Ergan
- Dept of Pulmonary and Critical Care, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Metin Akgun
- Dept of Pulmonary Diseases, School of Medicine, Ataturk University, Erzurum, Turkey
| | - Angela Maria Grazia Pacilli
- Dept of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Alma Mater University, Bologna, Italy
| | - Stefano Nava
- Dept of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Alma Mater University, Bologna, Italy
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Physiological predictors of Hypoxic Challenge Testing (HCT) outcomes in Interstitial Lung Disease (ILD). Respir Med 2018; 135:51-56. [PMID: 29414453 DOI: 10.1016/j.rmed.2017.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/04/2017] [Accepted: 12/31/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pre-flight risk assessments are currently recommended for all Interstitial Lung Disease (ILD) patients. Hypoxic challenge testing (HCT) can inform regarding the need for supplemental in-flight oxygen but variables which might predict the outcome of HCT and thus guide referral for assessment, are unknown. METHODS A retrospective analysis of ILD patients attending for HCT at three tertiary care ILD referral centres was undertaken to investigate the concordance between HCT and existing predictive equations for prediction of in-flight hypoxia. Physiological variables that might predict a hypoxaemic response to HCT were also explored with the aim of developing a practical pre-flight assessment algorithm for ILD patients. RESULTS A total of 106 ILD patients (69 of whom (65%) had Idiopathic Pulmonary Fibrosis (IPF)) underwent HCT. Of these, 54 (51%) patients (of whom 37 (69%) had IPF) failed HCT and were recommended supplemental in-flight oxygen. Existing predictive equations were unable to accurately predict the outcome of HCT. ILD patients who failed HCT had significantly lower resting SpO2, baseline PaO2, reduced walking distance, FEV1, FVC and TLCO, but higher GAP index than those who passed HCT. CONCLUSIONS TLCO >50% predicted and PaO2 >9.42 kPa were independent predictors for passing HCT. Using these discriminators, a novel, practical pre-flight algorithm for evaluation of ILD patients is proposed.
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Peña-Zarza JA, Osona B, Sailer S, Gil-Sanchez JA, Figuerola Mulet J. Assessing hypoxia risk during air travel after a severe asthma exacerbation in children. Ann Allergy Asthma Immunol 2017; 119:389-390. [PMID: 28870449 DOI: 10.1016/j.anai.2017.07.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/20/2017] [Accepted: 07/28/2017] [Indexed: 01/10/2023]
Affiliation(s)
| | - Borja Osona
- Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Sebastian Sailer
- Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain
| | | | - Joan Figuerola Mulet
- Department of Pediatrics, University Hospital Son Espases, Palma de Mallorca, Spain
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10
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Edvardsen E, Akerø A, Skjønsberg OH, Skrede B. Pre-flight evaluation of adult patients with cystic fibrosis: a cross-sectional study. BMC Res Notes 2017; 10:84. [PMID: 28166839 PMCID: PMC5292785 DOI: 10.1186/s13104-017-2386-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 01/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Air travel may imply a health hazard for patients with cystic fibrosis (CF) due to hypobaric environment in the aircraft cabin. The objective was to identify pre-flight variables, which might predict severe hypoxaemia in adult CF patients during air travel. METHODS Thirty adult CF-patients underwent pre-flight evaluation with spirometry, arterial oxygen tension (PaO2), pulse oximetry (SpO2) and cardiopulmonary exercise testing (CPET) at sea level (SL). The results were related to the PaO2 obtained during a hypoxia-altitude simulation test (HAST) in which a cabin altitude of 2438 m (8000 ft) was simulated by breathing 15.1% oxygen. RESULTS Four patients fulfilled the criteria for supplemental oxygen during air travel (PaO2 HAST < 6.6 kPa). While walking slowly during HAST, another eleven patients dropped below PaO2 HAST 6.6 kPa. Variables obtained during CPET (PaO2 CPET, SpO2 CPET, minute ventilation/carbon dioxide output, maximal oxygen uptake) showed the strongest correlation to PaO2 HAST. CONCLUSIONS Exercise testing might be of value for predicting in-flight hypoxaemia and thus the need for supplemental oxygen during air travel in CF patients. Trial registration The study is retrospectively listed in the ClinicalTrials.gov Protocol Registration System: NCT01569880 (date; 30/3/2012).
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Affiliation(s)
- Elisabeth Edvardsen
- Department of Pulmonary Medicine, Oslo University Hospital, Ullevål, Oslo, Norway. .,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
| | - Aina Akerø
- Department of Pulmonary Medicine, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Ole Henning Skjønsberg
- Department of Pulmonary Medicine, Oslo University Hospital, Ullevål, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Skrede
- Department of Pulmonary Medicine, Oslo University Hospital, Ullevål, Oslo, Norway.,National Center for Cystic Fibrosis, Oslo University Hospital, Oslo, Norway
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Khalifa MAAA, Mohamed GAM. Concordance between hypoxic challenge testing and predictive equations for hypoxic flight assessment in chronic obstructive pulmonary disease patients prior to air travel. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2014.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
Patients with chronic lung disease may have mild hypoxemia at sea level. Some of these cases may go unrecognized, and even among those who are known to be hypoxemic, some do not use supplemental oxygen. During air travel in a hypobaric hypoxic environment, compensatory pulmonary mechanisms may be inadequate in patients with lung disease despite normal sea-level oxygen requirements. In addition, compensatory cardiovascular mechanisms may be less effective in some patients who are unable to increase cardiac output. Air travel also presents an increased risk of venous thromboembolism. Patients with cystic lung disease may also be at increased risk of pneumothorax. Although overall this risk appears to be relatively low, should a pneumothorax occur, it could present a significant challenge to the patient with chronic lung disease, particularly if hypoxemia is already present. As such, a thorough assessment of patients with chronic lung disease and cardiac disease who are contemplating air travel should be performed. The duration of the planned flight, the anticipated levels of activity, comorbid illnesses, and the presence of risk factors for venous thromboembolism are important considerations. Hypobaric hypoxic challenge testing reproduces an environment most similar to that encountered during actual air travel; however, it is not widely available. Assessment for hypoxia is otherwise best performed using a normobaric hypoxic challenge test. Patients in need of supplemental oxygen need to contact the airline and request this accommodation during flight. They should also be advised on arranging portable oxygen concentrators before air travel, and a discussion of the potential risks of travel should take place.
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Ling IT, Singh B, James AL, Hillman DR. Vital capacity and oxygen saturation at rest and after exercise predict hypoxaemia during hypoxic inhalation test in patients with respiratory disease. Respirology 2013; 18:507-13. [DOI: 10.1111/resp.12036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 08/27/2012] [Accepted: 09/27/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Ivan T. Ling
- Department of Pulmonary Physiology and Sleep Medicine; Sir Charles Gairdner Hospital; Perth; Western Australia; Australia
| | - Bhajan Singh
- Department of Pulmonary Physiology and Sleep Medicine; Sir Charles Gairdner Hospital; Perth; Western Australia; Australia
| | - Alan L. James
- Department of Pulmonary Physiology and Sleep Medicine; Sir Charles Gairdner Hospital; Perth; Western Australia; Australia
| | - David R. Hillman
- Department of Pulmonary Physiology and Sleep Medicine; Sir Charles Gairdner Hospital; Perth; Western Australia; Australia
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Felkai P, Böszörményi Nagy G, Gyarmati I. [Preparing patients with chronic pulmonary disease for air travel]. Orv Hetil 2013; 154:323-37. [PMID: 23434882 DOI: 10.1556/oh.2013.29546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Flying is the most important way of travelling in the continually growing international tourism. Number of passengers and those with preexisting diseases, mainly with cardiopulmonary problems, is increasing over years. One of the main tasks of the pre-travel advice is to assess tolerance to hypoxia of the traveler, and specify the necessity, as well as the type and volume of supplementary oxygen therapy. It is indispensable to know the cabin-environment and impact of that on the travelers' health. Travel medicine specialist has to be aware of the examinations which provide information for the appropriate decision on the fit-to-fly condition of the patient. The physician who prepares the patient with chronic obstructive pulmonary disease for repatriation by regular flight and the escorting doctor have to be fully aware of the possibilities, modalities, advantages and contraindications of the on-board oxygen supply and therapy. In this review, the authors give a summary of literature data, outline the tools of in-flight oxygen therapy as well as discuss possibilities for the preflight assessment of patients' condition including blood gas parameters required for safe air travel, as recommended in international medical literature. The preparation process for repatriation of patients with chronic obstructive pulmonary disease is also discussed.
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Affiliation(s)
- Péter Felkai
- SOS Hungary Orvosi Szolgálat Budapest. peter.felkaisoshungary.hu
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Burns RM, Peacock AJ, Johnson MK, Church AC. Hypoxaemia in patients with pulmonary arterial hypertension during simulated air travel. Respir Med 2012; 107:298-304. [PMID: 23127571 DOI: 10.1016/j.rmed.2012.10.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 10/02/2012] [Accepted: 10/15/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent air travel recommendations suggest patients with precapillary pulmonary hypertension (PCPH) in New York Heart Association (NYHA) functional class 3 and 4 should have in-flight oxygen without the need for pre-flight testing. However it remains unclear as to how best to determine patients fitness to fly. METHODS This study (i) investigates the effect of hypoxic challenge testing (HCT) on the arterial oxygen levels in a cohort of 36 patients with PCPH and (ii) compares the relative frequency with which FC and HCT predict the requirement for in-flight oxygen. RESULTS The degree of arterial hypoxaemia induced by HCT (fall in partial pressure of oxygen in arterial blood (PaO(2)) 2.36 kPa, 95% CI 2.06-2.66 kPa) was similar to the drop observed in other published studies of chronic respiratory diseases. Following current air travel recommendations based on FC, 25 patients of the cohort would require in-flight oxygen whilst 10 subjects failed the HCT. Fourteen subjects had flown post-diagnosis. Of these, nine subjects should have had in-flight oxygen based on FC but were asymptomatic without. Also one who passed the HCT had developed symptoms during the flight whilst three who failed the HCT were asymptomatic flying without in-flight oxygen. CONCLUSIONS Hypoxaemia induced by simulated air travel in patients with PCPH is similar to that seen in published studies of patients with other chronic respiratory diseases. HCT failed to predict correctly who had developed symptoms during an aircraft flight in a significant minority of the study subjects. Similarly guidelines based on functional class result in a major increase in the proportion of patients being advised to use oxygen, many of whom had been asymptomatic on previous flights without it. More work is required to improve prediction of need for in-flight oxygen in patients with PCPH.
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Affiliation(s)
- R M Burns
- Scottish Pulmonary Vascular Unit, Golden Jubilee Hospital, Agamemnon Street, Clydebank, Glasgow G81 4DY, UK
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Thamm M, Voswinckel R, Tiede H, Lendeckel F, Grimminger F, Seeger W, Ghofrani HA. Air travel can be safe and well tolerated in patients with clinically stable pulmonary hypertension. Pulm Circ 2011; 1:239-43. [PMID: 22034609 PMCID: PMC3198644 DOI: 10.4103/2045-8932.83451] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Our aim was to determine what proportion of patients with pulmonary hypertension (PH) has undertaken air travel contrary to the general medical advice and to characterize these patients according to disease severity and medical treatment. In cooperation with Pulmonale Hypertonie e.V., the German patient organization, a questionnaire was distributed. In total, 430 of 720 questionnaires were returned completed. Of the 179 patients who travelled at least once by air, the distribution of New York Heart Association functional classes I/ II/ III/ IV was 2/ 77/ 74/ 8, respectively; 83 patients were receiving monotherapy; 58 patients were receiving a combination of two or more therapies; 57 patients were on long-term ambulatory oxygen treatment; and 29 patients used supplemental oxygen while travelling. Overall, 20 adverse events were reported, mostly of mild to moderate severity (i.e., peripheral edema, dyspnea), with need of medical intervention in only 7 cases. The 251 patients who did not travel by air were, on average, in more advanced stages of disease and/or clinically unstable. In conclusion, a majority of patients (159 out of 179) did not experience any complications during or directly after the flight even though no special precautions were taken. Thus we conclude that for patients with PH in a stable clinical condition, air travel can be safe and well tolerated.
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Affiliation(s)
- Melanie Thamm
- Department of Internal Medicine, Medical Clinic II/V, University Hospital of Giessen and Marburg GmbH, Giessen, Germany
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Burtscher M, Mairer K, Wille M, Gatterer H, Ruedl G, Faulhaber M, Sumann G. Short-term exposure to hypoxia for work and leisure activities in health and disease: which level of hypoxia is safe? Sleep Breath 2011; 16:435-42. [PMID: 21499843 DOI: 10.1007/s11325-011-0521-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 03/16/2011] [Accepted: 04/05/2011] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Exposures to natural and simulated altitudes entail reduced oxygen availability and thus hypoxia. Depending on the level of hypoxia, the duration of exposure, the individual susceptibility, and preexisting diseases, health problems of variable severity may arise. Although millions of people are regularly or occasionally performing mountain sport activities, are transported by airplanes, and are more and more frequently exposed to short-term hypoxia in athletic training facilities or at their workplace, e.g., with fire control systems, there is no clear consensus on the level of hypoxia which is generally well tolerated by human beings when acutely exposed for short durations (hours to several days). CONCLUSIONS Available data from peer-reviewed literature report adaptive responses even to altitudes below 2,000 m or corresponding normobaric hypoxia (F(i)O(2) > 16.4%), but they also suggest that most of exposed subjects without severe preexisting diseases can tolerate altitudes up to 3,000 m (F(i)O(2) > 14.5%) well. However, physical activity and unusual environmental conditions may increase the risk to get sick. Large interindividual variations of responses to hypoxia have to be expected, especially in persons with preexisting diseases. Thus, the assessment of those responses by hypoxic challenge testing may be helpful whenever possible.
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Affiliation(s)
- Martin Burtscher
- Department of Sport Science, Medical Section, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria.
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Predicting the need for supplemental oxygen during airline flight in patients with chronic pulmonary disease: a comparison of predictive equations and altitude simulation. Can Respir J 2010; 16:119-24. [PMID: 19707606 DOI: 10.1155/2009/371901] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patients with chronic pulmonary diseases are at increased risk of hypoxemia when travelling by air. Screening guidelines, predictive equations based on ground level measurements and altitude simulation laboratory procedures have been recommended for determining risk but have not been rigorously evaluated and compared. OBJECTIVES To determine the adequacy of screening recommendations that identify patients at risk of hypoxemia at altitude, to evaluate the specificity and sensitivity of published predictive equations, and to analyze other possible predictors of the need for in-flight oxygen. METHODS The charts of 27 consecutive eligible patients referred for hypoxia altitude simulation testing before flight were reviewed. Patients breathed a fraction of inspired oxygen of 0.15 for 20 min. This patient population was compared with the screening recommendations made by six official bodies and compared the partial pressure of arterial oxygen (PaO(2)) obtained during altitude simulation with the PaO(2) predicted by 16 published predictive equations. RESULTS Of the 27 subjects, 25% to 33% who were predicted to maintain adequate oxygenation in flight by the British Thoracic Society, Aerospace Medical Association or American Thoracic Society guidelines became hypoxemic during altitude simulation. The 16 predictive equations were markedly inaccurate in predicting the PaO(2) measured during altitude simulation; only one had a positive predictive value of greater than 30%. Regression analysis identified PaO(2) at ground level (r=0.50; P=0.009), diffusion capacity (r=0.56; P=0.05) and per cent forced expiratory volume in 1 s (r=0.57; P=0.009) as having predictive value for hypoxia at altitude. CONCLUSIONS Current screening recommendations for determining which patients require formal assessment of oxygen during flight are inadequate. Predictive equations based on sea level variables provide poor estimates of PaO(2) measured during altitude simulation.
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Leroy S, Tercé G, Wemeau L, Wallaert B. L’asthme dans l’avion. REVUE FRANÇAISE D'ALLERGOLOGIE 2010. [DOI: 10.1016/j.reval.2010.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Santé des voyageurs sur des vols aériens de longue durée. Rôle du médecin traitant. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2010. [DOI: 10.1016/s0001-4079(19)32233-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
Almost 2 billion people travel aboard commercial airlines every year. Health-care providers and travellers need to be aware of the potential health risks associated with air travel. Environmental and physiological changes that occur during routine commercial flights lead to mild hypoxia and gas expansion, which can exacerbate chronic medical conditions or incite acute in-flight medical events. The association between venous thromboembolism and long-haul flights, cosmic-radiation exposure, jet lag, and cabin-air quality are growing health-care issues associated with air travel. In-flight medical events are increasingly frequent because a growing number of individuals with pre-existing medical conditions travel by air. Resources including basic and advanced medical kits, automated external defibrillators, and telemedical ground support are available onboard to assist flight crew and volunteering physicians in the management of in-flight medical emergencies.
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Affiliation(s)
- Danielle Silverman
- Department of Emergency Medicine, Georgetown University Hospital and Washington Hospital Center, Washington, DC, USA
| | - Mark Gendreau
- Department of Emergency Medicine, Lahey Clinic Medical Center, Burlington, MA, USA
- Tufts Medical School, Boston, MA, USA
- Correspondence to: Dr Mark Gendreau, Department of Emergency Medicine, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA
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Gilbert CR, Smith CM. Advanced lung disease: quality of life and role of palliative care. ACTA ACUST UNITED AC 2009; 76:63-70. [PMID: 19170219 DOI: 10.1002/msj.20091] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Advanced restrictive lung diseases remain a challenge for both the clinician and patient alike. Because there are few available treatment options that prolong survival for patients with diseases such as idiopathic pulmonary fibrosis, improvement in quality of life and palliation of significant symptoms become realistic treatment goals. Several validated instruments that assess quality of life and health-related quality of life have demonstrated the dramatic impact that lung disease has on patients. Quality-of-life assessments of patients with interstitial lung disease have commonly cited respiratory complaints as problematic, but other distressing symptoms often not addressed include fear, social isolation, anxiety, and depression. Not only do respiratory symptoms limit this patient population, but the awareness of decreased independence and ability for social participation also has an impact on the quality of life. Some patients describe a deepened spiritual well-being during their disease process; however, many patients' mental health suffers with experiences of fear, worry, anxiety, and panic. Many patients express desire for more attention to end-of-life issues from their physicians. Fears of worsening symptoms and suffocation exist with an expressed desire by most to die peacefully with symptom control. Interventions to improve quality of life are largely directed at symptom control. Pharmacologic and nonpharmacologic interventions have been helpful in relieving dyspnea. Studies have demonstrated that the use of supplemental oxygen in the face of advancing hypoxemia can have both positive and negative effects on quality of life. Patients using nasal prongs describe feelings of self-consciousness, embarrassment, and social withdrawal. Pulmonary rehabilitation is recommended, with some studies noting increased quality-of-life scores and decreased sensations of dyspnea. Sleep deprivation and poor sleep quality also have a negative impact on quality of life. Recognition and correction of nocturnal hypoxemia and other sleep disturbances should enhance quality of life in patients with restrictive lung disease; however, there is currently no evidence to support this claim. End-of-life care needs more attention by clinicians in the decision-making and preparatory phase. Physicians need to maintain their focus on quality-of-life issues as medical management shifts from curative therapies to comfort management therapies. Palliative care and hospice appear to be underused in patients with advanced diseases other than cancer. Because the only curative option for some end-stage restrictive lung diseases is lung transplantation, if transplantation is not an option, palliation of symptoms and hospice care may offer patients and families the opportunity to die with dignity and comfort.
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Affiliation(s)
- Christopher R Gilbert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Kelly PT, Swanney MP, Seccombe LM, Frampton C, Peters MJ, Beckert LE. Predicting the response to air travel in passengers with non-obstructive lung disease: are the current guidelines appropriate? Respirology 2009; 14:567-73. [PMID: 19386067 DOI: 10.1111/j.1440-1843.2009.01520.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Air travel guidelines recommend using baseline arterial oxygen levels and the hypoxic challenge test (HCT) to predict in-flight hypoxaemia and the requirement for in-flight oxygen in patients with lung disease. The purpose of the present study was to (i) quantify the hypoxaemic response to air travel and (ii) identify baseline correlate(s) to predict this response in passengers with non-obstructed lung disease. METHODS Fourteen passengers (seven women) with chronic non-obstructed lung disease volunteered for this study. The study involved three phases: (i) respiratory function testing; (ii) in-flight measures (SpO(2), cabin pressure and dyspnoea); and (iii) a HCT. The in-flight hypoxaemic response was compared with the baseline arterial oxygen level, respiratory function and the HCT. RESULTS All subjects flew without oxygen and no adverse events were recorded in-flight. Mean cabin pressure was 593 +/- 16 mm Hg. Pre-flight SpO(2) was 95 +/- 3% and significantly decreased to 85 +/- 9% in-flight, with further significant falls in subjects who walked during the flight (nadir SpO(2) 78 +/- 11%). The pre-flight SpO(2) showed the strongest correlation with in-flight SpO(2) (r = 0.91, P < 0.001). The HCT SpO(2) was moderately correlated to the in-flight SpO(2) (r = 0.58, P < 0.05). Spirometry, D(L,CO) and TLC measurements did not correlate with in-flight SpO(2). CONCLUSION Significant in-flight desaturation can be expected in passengers with non-obstructive lung disease. Respiratory function did not predict in-flight desaturation. We found a good relationship between pre-flight SpO(2) and in-flight SpO(2) which supports the role of pre-flight oximetry for predicting in-flight hypoxaemia in passengers with non-obstructed lung disease.
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Affiliation(s)
- Paul T Kelly
- Respiratory Physiology Laboratory, Christchurch Hospital, Christchurch, New Zealand.
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