Friday, July 03, 2009

Pre-Flight Testing Urged for All Travelers With Restrictive Lung Disease

As someone who had a lung transplant as a result of restrictive lung disease (IPF) this article has special importance for me. The authors suggest that anyone with a resting oxygen saturation less than 95% should be assessed for the need for supplemental in-flight oxygen.

From Medscape Pulmonary Medicine

All patients with severe extrapulmonary restrictive lung disease should undergo a hypoxic challenge test prior to air travel, according to a report in the June issue of Thorax.

The authors of the paper, led by Dr. M. W. Elliott from St. James's University Hospital, Leeds, UK, note that according to British Thoracic Society guidelines, travelers with respiratory disease do not need to be assessed for a need for supplemental in-flight oxygen if their resting oxygen saturation is greater than 95%. These guidelines, the authors say, are based "on anecdotal evidence and little data."

To assess the appropriateness of the British guidelines, the researchers administered hypoxic challenge tests to 19 adults with kyphoscoliosis or neuromuscular disease, all of whom were at risk for nocturnal hypoventilation and 15 of whom used home ventilators while sleeping.

All subjects completed the challenge with no adverse effects, although testing was aborted in 5 patients when oxygen saturation fell below 85%. Three of these 5 had resting oxygen saturation levels above 95%.

Based on the results of the hypoxic challenge tests, supplemental in-flight oxygen would be recommended for 50% of the patients with resting oxygen saturation above 95% (who would not be deemed by the British Thoracic Society guidelines to require in-flight oxygen) and 71% of patients with borderline baseline oxygen saturation (92-95%).

Only 4 of the 19 patients in this study would definitely not require in-flight oxygen based on the test result, the researchers note.

There was no consistent relationship between the change in partial pressure of arterial oxygen (PaO2) and the change in partial pressure of arterial carbon dioxide (PaCO2) during hypoxic challenge, the investigators say.

"This finding suggests that all patients with severe extrapulmonary restrictive lung disease should undergo assessment with hypoxic challenge test prior to air travel," the authors conclude. "The study confirms that even patients with a resting saturation of >95% can desaturate significantly during hypoxic challenge."

"A decision as to whether it is safe for a patient to fly should be made by an experienced clinician...based on a number of factors, which should include previous travel experience, the patient's overall condition, and the results of a hypoxic challenge test," they add.

Thorax 2009;64:532-534.

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