title: Air travel and chronic obstructive pulmonary disease: a new algorithm for pre-flight evaluation.
abstract: BACKGROUND
  The reduced pressure in the aircraft cabin may cause significant hypoxaemia and respiratory distress in patients with chronic obstructive pulmonary disease (COPD). Simple and reliable methods for predicting the need for supplemental oxygen during air travel have been requested.
  
  
  OBJECTIVE
  To construct a pre-flight evaluation algorithm for patients with COPD.
  
  
  METHODS
  In this prospective, cross-sectional study of 100 patients with COPD referred to hypoxia-altitude simulation test (HAST), sea level pulse oximetry at rest (SpO(2 SL)) and exercise desaturation (SpO(2 6MWT)) were used to evaluate whether the patient is fit to fly without further assessment, needs further evaluation with HAST or should receive in-flight supplemental oxygen without further evaluation. HAST was used as the reference method.
  
  
  RESULTS
  An algorithm was constructed using a combination of SpO(2 SL) and SpO(2 6MWT). Categories for SpO(2 SL) were >95%, 92-95% and <92%, the cut-off value for SpO(2 6MWT) was calculated as 84%. Arterial oxygen pressure (PaO(2 HAST)) <6.6 kPa was the criterion for recommending supplemental oxygen. This algorithm had a sensitivity of 100% and a specificity of 80% when tested prospectively on an independent sample of patients with COPD (n=50). Patients with SpO(2 SL) >95% combined with SpO(2 6MWT) ≥84% may travel by air without further assessment. In-flight supplemental oxygen is recommended if SpO(2 SL)=92-95% combined with SpO(2 6MWT) <84% or if SpO(2 SL) <92%. Otherwise, HAST should be performed.
  
  
  CONCLUSIONS
  The presented algorithm is simple and appears to be a reliable tool for pre-flight evaluation of patients with COPD.
authors: Department of Respiratory Physiology, Glittreklinikken, Hakadal, Norway. anne.edvardsen@glittreklinikken.no
authors: Anne
authors: A
authors: Edvardsen
authors: Aina
authors: A
authors: Akerø
authors: Carl C
authors: CC
authors: Christensen
authors: Morten
authors: M
authors: Ryg
authors: Ole H
authors: OH
authors: Skjønsberg
mesh_terms: D000337:Aerospace Medicine; D000368:Aged; D000465:Algorithms; D000531:Altitude; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000097:blood / Q000209:etiology* / Q000517:prevention & control*; D008297:Male; D010092:Oximetry; D010100:Oxygen / Q000008:administration & dosage; D011237:Predictive Value of Tests; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013147:Spirometry; D014195:Travel
chemical_list: D010100:Oxygen