General Recommendation [12

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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 [44].

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).


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