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Effect of Natural Oxygen Enrichment at Low Altitude on Oxygen-Dependent Patients with End-Stage Lung Disease

Mordechai R. Kramer, MD; Chaim Springer, MD; Neville Berkman, MBBCh; Ephraim Bar-Yishay, PhD; Avraham Avital, MD; Avigdor Mandelberg, MD; Dov Effron, MD; and Simon Godfrey, MD, PhD, FRCP
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From the Institute of Pulmonology, Hadassah University Hospital, Jerusalem, Israel. Requests for Reprints: Mordechai R. Kramer, MD, Institute of Pulmonology, Hadassah University Hospital, P.O. Box 12000, Jerusalem, Israel.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;121(9):658-662. doi:10.7326/0003-4819-121-9-199411010-00005
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Objective: To assess the effect of lowering altitude to that of the lowest place on earth (Dead Sea) on arterial oxygenation and exercise performance in patients with hypoxemia and end-stage lung disease.

Design: A cohort of 10 patients.

Setting: Pulmonary function laboratories in Jerusalem, Israel, and at the Dead Sea.

Patients: 10 patients with end-stage lung disease who were receiving long-term oxygen therapy. The 4 males and 6 females were 12 to 77 years old. Four patients had chronic obstructive pulmonary disease; 2 had cystic fibrosis; 3 had pulmonary fibrosis; and 1 had pulmonary hypertension (thromboembolic). Mean forced vital capacity was 1.54 L (54% of predicted value) and mean forced expiratory volume in 1 second was 0.85 L (35% of predicted value).

Measurements: Spirometry, blood gas analysis, progressive exercise testing, and sleep oximetry were done in Jerusalem (altitude, 800 m above sea level; barometric pressure, 696 mm Hg); the same measurements were done 6 days after arrival at the Dead Sea (altitude, 402 m below sea level; barometric pressure, 800 mm Hg) and then 7 to 14 days later in Jerusalem.

Results: Arterial oxygenation increased from a median partial pressure of arterial oxygen of 51.6 mm Hg in Jerusalem to 67.0 mm Hg at the Dead Sea, an increase of 15.2 mm Hg (95% CI of paired difference, 4.1 to 20.4 mm Hg; P = 0.001). Partial pressure of arterial carbon dioxide increased from a median of 43.2 to 45.9 mm Hg, an increase of 2.7 mm Hg (CI, 0.5 to 6.4 mm Hg; P = 0.004), with a borderline significant change in the alveolar-arterial gradient. Arterial oxygen saturation increased from a median of 87.7% to 92.8%, a change of 4.8% (CI, 1.9% to 9.8%; P = 0.003). Exercise performance also improved as maximum oxygen uptake increased from a median of 827 mL/min to 1056 mL/min, an increase of 203 mL/min (CI, 54 to 388 mL/min; P = 0.006). Sleep oximetry also improved as median arterial oxygen saturation measured during sleep increased from 85% to 90%, a change of 5% (CI, 2% to 7%; P = 0.005), and percentage of sleep time with an oxygen saturation rate of 90% or more increased from a median of 24% to 73%, a change of 49% (CI, 20% to 87%; P = 0.02). No change in spirometry was noted. All patients felt less dyspneic and reported improved functional capacity with reduced need for oxygen.

Conclusion: Descent to low altitude can improve arterial oxygenation, exercise performance, and sleep oximetry and consequently the quality of life in patients with hypoxemia and advanced lung disease.


Grahic Jump Location
Figure 1.
Blood gas analysis of 10 patients in Jerusalem (before traveling to the Dead Sea resort) and at the Dead Sea.Top left.O2Top right.CO2Bottom left.O2Bottom right.

Partial pressure of arterial oxygen (Pa ). Partial pressure of arterial carbon dioxide (Pa ). Arterial oxygen saturation (Sa ). Alveolar-arterial (A-a) gradient.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Sleep oximetry in six patients in Jerusalem and at the Dead Sea.Left.Right.

Mean sleep arterial oxygen saturation. Percentage of sleep time with saturation greater than 90%.

Grahic Jump Location




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