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Hypoxemia during Air Travel in Patients with Chronic Obstructive Pulmonary Disease

Thomas A. Dillard, MD; Benjamin W. Berg, MD; Krishnan R. Rajagopal, MD; James W. Dooley, PhD; and William J. Mehm, PhD
[+] Article and Author Information

Grant Support: Supported in part by WRAMC DCI protocol #1724.

Requests for Reprints: Thomas A. Dillard, MD, Pulmonary Disease Service, Walter Reed Army Medical Center, Washington, DC 20307-5001.

Current Author Addresses: Drs. Dillard and Rajagopal: Pulmonary Disease Service, Walter Reed Army Medical Center, Washington, DC 20307-5001.

Dr. Berg: Department of Medicine, Tripler Army Medical Center, Honolulu, HI 96859.

Dr. Dooley: DGMC/SGPH, Travis AFB, CA 94535-5300.

Dr. Mehm: 2105 Department of Scientific Laboratories, Armed Forces Institute of Pathology, Washington, DC 20307.


Ann Intern Med. 1989;111(5):362-367. doi:10.7326/0003-4819-111-5-362
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Study Objective: To quantitate and identify determinants of the severity of hypoxemia during air travel in patients with chronic obstructive pulmonary disease.

Design: Prospective study of physiologic variables before and during intervention.

Setting: Referral-based pulmonary disease clinic at a U.S. Army medical center.

Patients: Eighteen ambulatory retired servicemen (age 68 ± 6 [SD] years) with severe chronic obstructive pulmonary disease (forced expiratory volume in the first second [FEV1] 31% ± 10% of predicted).

Intervention: Altitude simulation equivalent to 2438 meters (8000 feet) above sea level in a hypobaric chamber.

Measurements and Main Results: Radial artery catheter blood oxygen tension in the patients declined from a ground value (PaO2G) at sea level of 72.4 ± 9 mm Hg to an altitude value (PaO2Alt) of 47.4 ± 6 mm Hg after 45 minutes of steady state hypobaric exposure. The PaO2G correlated with PaO2Alt (r = 0.587; P < 0.01). Multiple regression analysis revealed that the preflight FEV1 reduced the variability in PaO2Alt not explained by PaO2G in the equation: PaO2Alt = 0.453 [PaO2G] + 0.386 [FEV1% predicted] + 2.440 (r = 0.847; P < 0.001). Residuals from two previously published formulas using PaO2G also correlated with FEV1 (r ≥ 0.765; P < 0.001).

Conclusions: Arterial blood oxygen tension declined to clinically significant levels in most patients during hypobaric exposure. When combined with the preflight arterial PO2 at ground level (PaO2G), the measurement of the preflight FEV1 improved prediction of PaO2 at altitude (PaO2Alt) in patients with severe chronic obstructive pulmonary disease.

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