In conclusion, hypoxic tests with the addition of spirometric testing are useful to the physician for the prediction of a patient's condition at altitudes different from the habitual residence [36,19,20,21,9,10]. The British Thoracic Society recommendations for respiratory patients planning air travel state that a minimum PaO2 of 70 mmHg (9.3 kPa) at sea level is required in order to obtain an arterial oxygen tension not lower than 55 mmHg (7.3 kPa) at an altitude of 2,438 m (8,000 ft) (BTS 2002).
In addition to the collection of clinical information and functional data, the physician should always ask patients about:
1. the altitude of their home residence
2. the altitude they are planning to reach
3. the length of their stay at altitude
4. the altitude at which they are going to sleep
5. the level of exertion that they anticipate during recreation
Each patient should be assessed individually. In the case where exposure to hypoxia is absolutely unavoidable (e.g., if someone has to travel by air) and a PaO2 below 60mmHg is predicted, supplemental oxygen must be considered. Furthermore, it could be useful to suggest that patients measure their pulse oximetry during altitude exposure, in order to avoid activities that result in severe desaturation .
When planning a trip to high altitude, patients must take into account the possibility of poor medical support, additional travel diseases and problems concerning emergency rescue. It is mandatory that patients should be in a stable phase of their disease and medical treatment should be optimised. Carrying supplemental oxygen devices can be logistically difficult, time-consuming and expensive; therefore, the pre-travel assessment indicating the need of supplemental oxygen should be performed carefully (details of air travel with supplemental oxygen are described in BTS 2002).
1. Allegra L, Cogo A, Legnani D, Diano PL, Fasano V, Negretto GG (1995). High altitude exposure reduces bronchial responsiveness to hypoosmolar aerosol in lowland asthmatics. Eur Resp. J 8:1842-1846.
2. Anholm JD, Milne EN, Stark P, Bourne JC, Friedman P (1999). Radiographic evidence of interstitial pulmonary oedema after exercise at altitude. J Appl Physiol. Feb;86(2):503-9.
3. Bartsch P, Mairbaurl H, Maggiorini M, Swenson ER (2005). Physiological aspects of high-altitude pulmonary edema. J Appl Physiol. Mar;98(3):1101-10.
4. Bert Paul (1875) La pression barometrique. Masson
5. Boulet LP, Turcotte H. (1991). Influence of water content of inspired air during and after exercise on induced bronchoconstriction. Eur. Respir. J. 4; 979-984.
6. BTS.(2002). Managing passengers with respiratory disease planning air travel: British Thoracic Society recommendations. Thorax 57: 289-304.
7. Cerretelli P (1961) Some aspects of the respiratory function in man acclimatized to high altitude. Int Z Angew Physiol;18:386-392.
8. Charpin D, Birnbaum J, Haddi H, Genard G, Lanteaume A, Toumi M, Farai F, Van der Brembt X, Vervolet D. (1991). Altitude and allergy to house dust mite. Am. Rev. Respir. Dis. 143; 983-986.
9. Chi-Lem G, Perez-Padilla R. (1998). Gas exchange at rest during simulated altitude in patients with chronic lung disease. Arch. Med. Res. Spring;29(1):57-62.
10. Christensen CC, Ryg M, Refvem OK, Skjonsberg OH. (2000). Development of severe hypoxaemia in chronic obstructive pulmonary disease patients at 2,438 m (8,000 ft) altitude. Eur. Respir. J. Apr;15(4):635-9.
11. Cogo A, Legnani D, Allegra L. (1997) Respiratory function at different altitudes. Respiration 64(6):416-21.
12. Cogo A, Fischer R, Schoene R (2004) Respiratory diseases and high altitude. High Alt Med Biol 5(4):435-44.
13. Cogo A, Paolucci E, Pomidori L, Schneider A, Bernardi L (2005) Extravascular lung fluid accumulation in èlite climbers at high altitude is a transient event and does not preclude a successful climb. ATS 2005 San Diego International Conference, May 20-25, 2005. Abstract 952886, Volume 2, p A779 (abstract).
14. Compte-Torrero L, Botella de Maglia J, de Diego-Damia A, Gomez-Perez L, Ramirez-Galleymore P, Perpina-Tordera M (2005) Changes in spirometric parameters and arterial oxygen saturation during a mountain ascent to over 3000 metres. Arch Bronconeumol. 41(10):547-52.
15. Cremona G, Asnaghi R, Baderna P, Brunetto A, Brutsaert T, Cavallaro C, Clark TM, Cogo A, Donis R, Lanfranchi P, Luks A, Novello N, Panzetta S, Perini L, Putnam M, Spagnolatti L, Wagner H, and Wagner PD (2002) Pulmonary extravascular fluid accumulation in recreational climbers: a prospective study. Lancet 359: 303-309.
16. Dagg KD, Thomson LJ, Clayton RA, Ramsay SG, Thomson NC. (1997). Effect of acute alterations in inspired oxygen tension on methacholine induced bronchoconstriction in patients with asthma. Thorax 52(5):453-7.
17. Deboeck G, Moraine JJ, Naeije R (2005) Respiratory muscle strength may explain hypoxia-induced decrease in vital capacity. Med Sci Sports Exerc 37(5):754-8.
18. Denjean A, Roux C, Herve P, Bonniot J-P, Comoy E, Duroux P, Gaultier C. (1988). Mild isocapnic hypoxia enhances the bronchial response to methacholine in asthmatic subjects. Am. Rev. Respir. Dis. 138: 789-793.
19. Dillard TA, Rosenberg AP, Berg BW (1993). Hypoxemia during altitude exposure. A meta-analysis of chronic obstructive pulmonary disease. Chest Feb;103(2):422-5
20. Dillard TA, Moores LK, Bilello KL, Phillips YY (1995). The preflight evaluation. A comparison of the hypoxia inhalation test with hypobaric exposure. Chest Feb;107(2):352-7.
Dillard TA, Rajagopal KR, Slivka WA, Berg BW, Mehm WJ, Lawless NP. (1998). Lung function during moderate hypobaric hypoxia in normal subjects and patients with chronic obstructive pulmonary disease. Aviat. Space Environ. Med. Oct;69(10):979-85. Dosman JA, Hodgson WC, Cockcroft DW. (1991). Effect of cold air on the bronchial response to inhaled histamine in patients with asthma. Am. Rev. Respir. Dis. 144 45-50. Fasano V, Bonardi D, Campigotto F, Donnaloja A, Farinatti M, Fioretti A, Gennari A, Pomidori L, Palange P, Cogo A (2004) Extravascular lung fluid accumulation does not immediately follow the increased capillary permeability during exposure to high altitude (HA). European Respiratory Journal (abstract).
Fasano V, Bonardi D, Campigotto F, Gennari A, Pomidori L, Valli G, Taccagni L, Gualdi Russo E, Cogo A (2005) Free fat mass and spirometric changes during high altitude exposure(HA) indicate a body fluid shift. Fundaments of Human Movement and Sport Practice 64-68.
Fasano V, Paolucci E, Pomidori L, Cogo A (2006) High-altitude exposure reduces inspiratory muscle strength. Int J Sports Med Oct 6 (e pub ahead of print). Fischer R, Lang SM, Bergner A, Huber RM (2005) Monitoring of expiratory flow rates and lung volumes during a high altitude expedition. Eur J Med Res 16;10(11):469-74. Fischer S., Renz D., Schaper W, Karliczek G.F. (2001). In vitro effects of dexamethasone on hypoxia-induced hyperpermeability and expression of vascular endothelial growth factor. Eur J Pharmacol 12;411(3):231-43).
Ge R.L., Matsuzawa Y, Takeoka M., Kubo K., Sekiguchi M., Kobayashi T. (1997). Low pulmonary diffusing capacity in subjects with acute mountain sickness. Chest 111(1):58-64.
Golan Y, Onn A., Villa Y, Avidor Y, Kivity S., Berger S.A., Shapira I., Levo Y, Giladi M. (2002). Asthma in adventure travellers: a prospective study evaluating the occurrence and risk factors for acute exacerbations. Arch. Intern. Med. Nov 25;162(21):2421-6. Hansen J.M., Olsen N.V., Feldt-Rasmussen B., Kanstrup I.L., Dechaux M., Dubray C., Richalet J.P. (1994). Albuminuria and overall capillary permeability of albumin in acute altitude hypoxia. J Appl Physiol;76(5):1922-7.
Hashimoto F., McWilliams B., Qualls C. (1997). Pulmonary ventilatory function decreases in proportion to increasing altitude. Wilderness Environ Med 8(4):214-7. Hoon R.S., Balasubramanian V., Tiwari S.C., Mathew O.P., Behl A., Sharma S.C., Chadha K.S. (1997). Changes in transthoracic electrical impedance at high altitude. Br Heart J 39(1):61-6.
Johnson M.K., Birch M., Carter R., Kinsella J., Stevenson R.D. (2005). Use of reactance to estimate transpulmonary resistance. Eur Respir J, 25, 1061-1069.
Jaeger J.J., Sylvester J.T., Cymerman A., Berberich J.J., Denniston J.C., Maher J.T. (1979).
Evidence for increased intrathoracic fluid volume in man at high altitude. J Appl Physiol
Jensen J.S., Borch-Johnsen K., Jensen G., Feldt-Rasmussen B. (1995). Microalbuminuria reflects a generalized transvascular albumin leakiness in clinically healthy subjects Clin. Sci.88(6):629-33.
Karrer W., Schmid T., Wuthrich O., Baldi W., Gall E., Portmann H.R.(1990). Respiration of patients with chronic lung disease at 500 and 1500 meter above sea level Schweiz Med. Wochenschr. Oct 27;120(43):1584-9.
Kaner RJ, Crystal RG (2004) Pathogenesis of high altitude pulmonary edema: Does alveolar epithelial lining fluid vascular endothelial growth factor exacerbate capillary leak? High Alt. Med. Biol. 5:399-409.
Klekamp JG, Jarzecka K, Hoover RL, Summar ML, Redmond N, Perkett EA (1997) Vascular endothelial growth factor is expressed in ovine pulmonary vascular smooth muscle cells in vitro and regulated by hypoxia and dexamethasone. Pediatr Res 42(6):744-9. Kronenberg R, Safar P, Lee J, Wright F, Noble W, Wahrenbrock E, Hickeyy R, Nemoto E, Severinghaus JW (1971) Pulmonary artery pressure and alveolar gas exchanges in man during acclimatization to 12470 ft. J Clin Inves 50:827-837.
40. Lewis DM, Bradwell AR, Shore AC, Beaman M, Tooke JE (1997) Capillary filtration coefficient and urinary albumin leak at altitude. Eur J Clin Invest 27(1):64—8.
41. Macklem PT (1998) The physiology of small airways. Am J Respir Crit Care Med 157, S181-S183.
42. Mason NP, Barry PW, Pollard AJ, Collier DJ, Taub NA, Miller MR, and Milledge JS. (2002) Serial changes in spirometry during an ascent to 5,300m in the Nepalese Himalayas. High Alt Med Biol 1: 185-195.
43. Mason NP, Petersen M, Melot C, Imanow B, Matveykine O, Gautier MT, Sarybaev A, Aldashev A, Mirrakhimov MM, Brown BH, Leathard AD, Naeije R (2003) Serial changes in nasal potential difference and lung electrical impedance tomography at high altitude. J Appl Physiol 94(5):2043-50.
44. Mehm WJ, Dillard TA, Berg BW, Dooley JW, Rajagopal KR. (1991). Accuracy of oxyhemoglobin saturation monitors during simulated altitude exposure of men with chronic obstructive pulmonary disease. Aviat. Space Environ. Med. May;62(5):418-21.
45. Miserocchi G, Passi A, Negrini D, Del Fabbro M, De Luca G (2001) Pulmonary interstitial pressure and tissue matrix structure in acute hypoxia. Am J Physiol Lung Cell Mol Physiol 280(5):L881-7.
46. Mosso A (1897) Fisiologia dell'uomo sulle Alpi. Treves, Torino.
47. Ogawa S, Gerlach H, Esposito C, Pasagian-Macaulay A, Brett J, Stern D (1990) Hypoxia modulates the barrier and coagulant function of cultured bovine endothelium. Increased monolayer permeability and induction of procoagulant properties. J Clin Invest 85(4):1090-8.
48. Ogawa S, Shreeniwas R, Brett J, Clauss M, Furie M, Stern DM (1990) The effect of hypoxia on capillary endothelial cell function: modulation of barrier and coagulant function. Br J Haematol 75(4):517-24.
49. Parker JC, Parker RE, Granger DN, Taylor AE (1981) Vascular permeability and trans-vascular fluid and protein transport in the dog lung. Circ Res 48(4):549-61.
50. Peacock AJ (1998). Asthma at altitude: the effect on asthma of the mountain environment and precautions for the traveller. The Asthma Journal september, 117-119.
51. Pellegrino R, Sterk PJ, Sont JK, Brusasco V (1998) Assessing the effect of deep inhalation on airway calibre: a novel approach to lung function in bronchial asthma and COPD. Eur Respir J 12(5):1219-27.
52. Rahn H, Hammond D (1951) Vital capacity at reduced barometric pressure. J Appl Physiol 4:715-724.
53. Schoene RB.(1999). Lung Disease at High Altitude. In Hypoxia into the next millennium. edited by R.R. Roach, P.D. Wagner and P.H. Hackett. Advances in Experimental Medicine and Biology vol. 474, Kluwer Academic, New York pp 47-56.
54. Schoene RB (2001) Limits of human lung function at high altitude. J Exp Biol 204(Pt 18):3121-7.
55. Schoene RB (2005) Limits of respiration at high altitude. Clin Chest Med 26(3):405-14.
56. Senn O, Clarenbach CF, Fischler M, Thalmann R, Brunner-La Rocca H, Egger P., Maggiorini M, Bloch KE (2006). Do changes in lung function predict high-altitude pulmonary edema at an early stage? Med Sci Sports Exerc. 38(9):1565-70.
57. Stelzner TJ, O'Brien RF, Sato K, Weil JV (1988) Hypoxia-induced increases in pulmonary transvascular protein escape in rats. Modulation by glucocorticoids. J Clin Invest 82(6):1840-7.
58. Tenney SM, Rahn H, Stound RC, Mithofer JC (1953) Adaptation to high altitude: changes in lung volumes during the first seven days at Mt Evans, Colorado.J Appl Physiol 5:607-613.
59. Ward MP, Milledge JS, West JB (2001) High Altitude Medicine and Physiology Chapman and Hall, London.
60. Wardlaw AJ. (1993). The role of air pollution in asthma. Clin Exp Allergy 23: 81-96.
61. Welsh CH, Wagner PD, Reeves JT, Lynch D, Cink TM, Armstrong J, Malconian MK, Rock PB, Houston CS (1993) Operation Everest. II: Spirometric and radiographic changes in acclimatized humans at simulated high altitudes. Am Rev Respir Dis 147(5):1239-44.
62. West JB, Colice GL, Lee YJ, Namba Y, Kurdak SS, Fu Z, Ou LC, Mathieu-Costello O. (1995). Pathogenesis of high-altitude pulmonary oedema: direct evidence of stress failure of pulmonary capillaries. Eur Respir J 8(4):523-9.
63. West JB (1990). Limiting factors for exercise at extreme altitudes. Clin Physiol 10(3):265-72.
64. Wood JG, Johnson JS, Mattioli LF, Gonzalez NC (2000). Systemic hypoxia increases leukocyte emigration and vascular permeability in conscious rats. J Appl Physiol 89(4):1561-8.
65. Woolcock AJ (1998). Effect of drugs on small airways. Am J Respir Crit Care Med 157, S203-S207.
66. Yan SF, Ogawa S, Stern DM, Pinsky DJ (1997) Hypoxia-induced modulation of endothe-lial cell properties: regulation of barrier-function and expression of interleukin-6. Kidney Int; 51(2):419-25.
Was this article helpful?
Do you hate the spring? Do you run at the site of a dog or cat? Do you carry around tissues wherever you go? Youre not alone. 51 Ways to Reduce Allergies can help. Find all these tips and more Start putting those tissues away. Get Your Copy Of 51 Ways to Reduce Allergies Today.