Advising patients with pulmonary disease on air travel

Article Abstract:

Patients with diverse pulmonary diseases can suffer from temporary hypoxemia, or insufficient oxygen, when traveling on airplanes, due to lower levels of oxygen at increasing altitudes. This is in spite of the fact that modern airplanes are pressurized. However, the combination of recent advances in the assessment of physiology, treatment with drugs, lightweight portable oxygen units and oxygen delivery systems has allowed patients with pulmonary diseases to still travel on airplanes. Patients with pulmonary disease must have a physical examination and undergo laboratory tests to determine the best methods of managing their condition in flight. Patients who are clinically stable and have the ability to exercise without shortness of breath or difficulty breathing will probably have no problems in flight. However, some patients meeting these criteria still have problems when flying. Patients who are receiving supplemental oxygen at ground level will of course require supplemental oxygen when flying, often at higher flow rates. The individual's normal arterial oxygen pressure is the most important determinant of how he will tolerate the reduced oxygen in flight. Predictive equations have been devised that are based on the arterial oxygen pressure. However, these equations are not always accurate because of the variety of pulmonary conditions that affect patients. The equations also do not predict symptoms or the effects of the lack of oxygen upon other complicating conditions of the patients, such as anemia, heart problems and certain cerebrovascular diseases. Altitude stress tests, using either hypoxic gas breathing or monitoring in a hypobaric (low pressure) chamber, should be given to patients whose arterial pressure is low. This kind of testing can give the best indication of how well an individual will do in the air. Arrangements must be made with the airlines for in-flight oxygen. By law, the airlines must supply oxygen for those who need it. However, there are no standardized policies or equipment among US air carriers, which leads to inefficiency and inconvenience for the patients. A national airline policy for the availability of supplemental oxygen for patients with pulmonary diseases is needed in the United States. (Consumer Summary produced by Reliance Medical Information, Inc.)

Airlines, Social policy, Lung diseases, editorial

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Hypoxemia during air travel in patients with chronic obstructive pulmonary disease

Article Abstract:

Patients with diverse pulmonary diseases can suffer from temporary hypoxemia, or insufficient oxygen in the bloodstream, while traveling on airplanes. This is due to lower levels of oxygen at increasing altitudes, even though modern airplanes are pressurized. Arterial oxygen pressure is the most important determinant of how an individual will tolerate the reduced oxygen in flight. Supplemental oxygen is recommended if arterial blood pressure should fall below 50 mm Hg during flight. The arterial blood pressure of eighteen patients with chronic obstructive pulmonary disease was examined after exposure to hypobaric (low-pressure) oxygen, in a chamber which simulated the amount of oxygen available at various altitudes. The arterial oxygen pressure and also the forced expiratory volume in one second, which measures the severity of airflow obstruction, were both useful for predicting how patients with pulmonary disease would do with decreased oxygen. Predictive equations were devised with these two variables. These equations can be used to assist making an appropriate clinical decision if a patient needs supplemental oxygen while in flight. However, the equations do not predict symptoms, nor the effects of the lack of oxygen upon other complicating conditions, such as anemia, heart problems or certain cerebrovascular diseases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Oxygen, Pulmonary function tests, Oxygen in the body

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Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease

Article Abstract:

The benefits of a comprehensive rehabilitation program for patients with chronic obstructive lung diseases seem to be significant but short-lived as compared to a more basic education program. One hundred and nineteen patients who participated in the comprehensive rehabilitation program received personal exercise training, respiratory care training, classroom and support group time. Those in an education control group attended a series of classes with discussion time. The exercise component of the more comprehensive program produced the most encouraging results. Two months into the program, rehabilitation patients could endure nearly twice as many minutes on a treadmill as those patients in the education control. However, this difference disappeared with time. An expected reduction in number of hospital stays and the corresponding cost savings did not materialize. There was also no notable long term improvement in the patients' quality of life nor in lung function. There were, however, moderate improvements in overall exercise achievement for both groups.

Care and treatment, Exercise therapy, Breathing exercises

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