Lung function during moderate hypobaric hypoxia in normal subjects and patients with chronic obstructive pulmonary disease.
BACKGROUND
We sought to describe changes in spirometric variables and lung volume subdivisions in healthy subjects and patients with chronic obstructive pulmonary disease (COPD) during moderate acute hypobaric hypoxia as occurs during air travel. We further questioned whether changes in lung function may associate with reduced maximum ventilation or worsened arterial blood gases.


METHODS
Ambulatory patients with COPD and healthy adults comprised the study populations (n = 27). We obtained baseline measurements of spirometry, lung volumes and arterial blood gases from each subject at sea level and repeated measurements during altitude exposure to 8000 ft (2438 m) above sea level in a man-rated hypobaric chamber.


RESULTS
Six COPD patients and three healthy subjects had declines in FVC during altitude exposure greater than the 95% confidence interval (CI) for expected within day variability (p < 0.05). Average forced vital capacity (FVC) declined by 0.123 +/- 0.254 L (mean +/- SD; 95% CI = -0.255, -0.020; p < 0.05) for all subjects combined. The magnitude of decline in FVC did not differ between groups (p > 0.05) and correlated with increasing residual volume (r = -0.455; <0.05). Change in maximum voluntary ventilation (MVV) in the COPD patients equaled -1.244 +/- 4.797 L x min(-1) (95% CI = -3.71, 1.22; p = 0.301). Decline in maximum voluntary ventilation (MVV) in the COPD patients correlated with decreased FVC (r = 0.630) and increased RV (r = -0.546; p < 0.05). Changes in spirometric variables for patients and controls did not explain significant variability in the arterial blood gas variables PaO2, PaCO2 or pH at altitude.


CONCLUSIONS
We observed a decline in forced vital capacity in some COPD patients and normal subjects greater than expected for within day variability. Spirometric changes correlated with changes in reduced maximum voluntary ventilation in the patients but not with changes in resting arterial blood gases.
Department of Medicine, Madigan Army Medical Center, Tacoma, WA 98431-5000 USA.
T A
TA
Dillard
K R
KR
Rajagopal
W A
WA
Slivka
B W
BW
Berg
W J
WJ
Mehm
N P
NP
Lawless
D000328:Adult; D000368:Aged; D000531:Altitude; D001784:Blood Gas Analysis; D016022:Case-Control Studies; D006801:Humans; D000860:Hypoxia / Q000378:metabolism / Q000503:physiopathology*; D016014:Linear Models; D008173:Lung Diseases, Obstructive / Q000378:metabolism / Q000503:physiopathology*; D008176:Lung Volume Measurements; D011446:Prospective Studies; D012123:Pulmonary Ventilation; D013147:Spirometry