COPD and air travel: oxygen equipment and preflight titration of supplemental oxygen.
BACKGROUND
Patients with COPD may need supplemental oxygen during air travel to avoid development of severe hypoxemia. The current study evaluated whether the hypoxia-altitude simulation test (HAST), in which patients breathe 15.1% oxygen simulating aircraft conditions, can be used to establish the optimal dose of supplemental oxygen. Also, the various types of oxygen-delivery equipment allowed for air travel were compared.


METHODS
In a randomized crossover trial, 16 patients with COPD were exposed to alveolar hypoxia: in a hypobaric chamber (HC) at 2,438 m (8,000 ft) and with a HAST. During both tests, supplemental oxygen was given by nasal cannula (NC) with (1) continuous flow, (2) an oxygen-conserving device, and (3) a portable oxygen concentrator (POC).


RESULTS
PaO(2) kPa (mm Hg) while in the HC and during the HAST with supplemental oxygen at 2 L/min (pulse setting 2) on devices 1 to 3 was (1) 8.6 ± 1.0 (65 ± 8) vs 12.5 ± 2.4 (94 ± 18) (P < .001), (2) 8.6 ± 1.6 (64 ± 12) vs 9.7 ± 1.5 (73 ± 11) (P < .001), and (3) 7.7 ± 0.9 (58 ± 7) vs 8.2 ± 1.1 (62 ± 8) (P= .003), respectively.


CONCLUSIONS
The HAST may be used to identify patients needing supplemental oxygen during air travel. However, oxygen titration using an NC during a HAST causes accumulation of oxygen within the facemask and underestimates the oxygen dose required. When comparing the various types of oxygen-delivery equipment in an HC at 2,438 m (8,000 ft), compressed gaseous oxygen with continuous flow or with an oxygen-conserving device resulted in the same PaO(2), whereas a POC showed significantly lower PaO(2) values.


BACKGROUND
ClinicalTrials.gov; No.: Identifier: NCT01019538; URL: clinicaltrials.gov.
Department of Pulmonary Medicine, Oslo University Hospital, Oslo. Electronic address: aina.akero@medisin.uio.no.
Aina
A
Akerø
Department of Respiratory Physiology, Glittreklinikken, Hakadal, Norway.
Anne
A
Edvardsen
The Institute of Aviation Medicine, Oslo; Department of Respiratory Physiology, Glittreklinikken, Hakadal, Norway.
Carl C
CC
Christensen
The Institute of Aviation Medicine, Oslo.
Jan O
JO
Owe
Department of Respiratory Physiology, Glittreklinikken, Hakadal, Norway.
Morten
M
Ryg
Department of Pulmonary Medicine, Oslo University Hospital, Oslo.
Ole H
OH
Skjønsberg
D000328:Adult; D000368:Aged; D000401:Aircraft; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004867:Equipment Design; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage*; D010102:Oxygen Inhalation Therapy / Q000295:instrumentation*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*; D014195:Travel; D016896:Treatment Outcome
D010100:Oxygen