Pre-flight evaluation of adult patients with cystic fibrosis: a cross-sectional study

Elisabeth Edvardsen, Aina Akerø, Ole Henning Skjønsberg, Bjørn Skrede, Elisabeth Edvardsen, Aina Akerø, Ole Henning Skjønsberg, Bjørn Skrede

Abstract

Background: Air travel may imply a health hazard for patients with cystic fibrosis (CF) due to hypobaric environment in the aircraft cabin. The objective was to identify pre-flight variables, which might predict severe hypoxaemia in adult CF patients during air travel.

Methods: Thirty adult CF-patients underwent pre-flight evaluation with spirometry, arterial oxygen tension (PaO2), pulse oximetry (SpO2) and cardiopulmonary exercise testing (CPET) at sea level (SL). The results were related to the PaO2 obtained during a hypoxia-altitude simulation test (HAST) in which a cabin altitude of 2438 m (8000 ft) was simulated by breathing 15.1% oxygen.

Results: Four patients fulfilled the criteria for supplemental oxygen during air travel (PaO2 HAST < 6.6 kPa). While walking slowly during HAST, another eleven patients dropped below PaO2 HAST 6.6 kPa. Variables obtained during CPET (PaO2 CPET, SpO2 CPET, minute ventilation/carbon dioxide output, maximal oxygen uptake) showed the strongest correlation to PaO2 HAST.

Conclusions: Exercise testing might be of value for predicting in-flight hypoxaemia and thus the need for supplemental oxygen during air travel in CF patients. Trial registration The study is retrospectively listed in the ClinicalTrials.gov Protocol Registration System: NCT01569880 (date; 30/3/2012).

Keywords: Blood gas response; Cardiopulmonary exercise testing; Gas exchange; Hypoxia altitude simulation test; Pulmonary function.

Figures

Fig. 1
Fig. 1
Relationships between arterial oxygen partial pressure (PaO2) during Hypoxia Altitude Simulation Test (HAST) and forced expiratory volume in one second (FEV1) (a), pulse oximetry (SpO2) (b), PaO2 (c) and SaO2 at rest (d)
Fig. 2
Fig. 2
Relationships between arterial oxygen partial pressure (PaO2) during Hypoxia Altitude Simulation Test (HAST) and physiological variables during exercise; maximal oxygen uptake (a), ventilatory eqvivalent for carbon dioxide ratio (VE/VCO2) (b), pulse oximetry (SpO2) (c) and PaO2 (d)

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