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Welcome! Here we publish our views on new research and insights from the field of pulmonary medicine, most often focusing on topics related to exercise, nutrition, and other self-management techniques for those who suffer from chronic shortness of breath.

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Monday, November 1, 2010

COPD and air travel

For those who contend with persistent shortness of breath, the prospect of air travel can be intimidating. In fact, many COPD patients opt not to travel by air for fear of experiencing a shortness of breath attack during the flight (known alternatively as “hypoxia”, “dyspnea” or “air hunger” among pulmonary medicine professionals).

According to a new research paper published in the journal Respiratory Medicine, this is an understandable concern given that “At maximal cruising altitude, the cabin pressure is allowed to decrease to the equivalent of 2438 meters altitude. This may cause a significant decrease in arterial oxygen tension in patients with respiratory disease, such as chronic obstructive pulmonary disease (COPD).”

However, despite the lower in-flight air pressure and anxiety regarding travel, this new study showed that a majority of COPD patients participating in the study did in fact travel by air (54%) and a minority of these flyers actually experienced dyspnea and air hunger in-flight (28%). (Edvardsen A, et al. High prevalence of respiratory symptoms during air travel in patients with COPD. Respiratory Medicine. Epub online ahead of print. Doi:10.1016/j.rmed.2010.10.006).

The Norway-based study sought to examine and compare the air travel behavior of 391 COPD patients and 184 control subjects who did not have COPD. In particular, the researchers desired to understand the prevalence of dyspnea/air hunger among COPD patients while traveling and whether there were any pre-flight factors that influenced who might experience hypoxia/air hunger.

Of the 54% of COPD patients who had traveled by air within the previous two years, 50% had flown at least twice and 33% reported having flown four or more times. The most common flight duration noted by flying COPD patients was 3-6 hours. Surprisingly, only 9% of the 46% non-flying COPD patients reported avoiding air travel due to their lung condition (the most common reason for not flying among this group was “no reason to travel” –noted by 79% of the non-flying COPD patients).

By comparison, 86% of the control subjects without COPD had flown within the previous two years with approximately 40% having flown at least two times and 55% having flown four or more times. The average flight duration was about the same for control subjects as for COPD patients.

As one can see from these findings, fewer COPD patients participating in the study traveled by air versus those without COPD, and those COPD patients who did fly took fewer flights. Further, as one will see below, COPD patients were more apt to report in-flight shortness of breath symptoms.

When looking at the percentage of both groups who experienced hypoxia-like symptoms such as air hunger, 28% of the flying COPD patients in the study reported such symptoms. By comparison, 16% of the flying non-COPD control subjects in the study reported in-flight shortness of breath symptoms. After adjusting for external influencing factors (referred to by researchers as confounders), the study team concluded that flying COPD patients were 3 times more likely to experience shortness of breath related symptoms than those without COPD.

But…

Of particular note to us were the findings that the COPD patients who reported the fewest hypoxia symptoms during flight were those patients who reported low levels of dyspnea pre-flight and/or those who walked longer distances on the 6 minute walk test pre-flight (a common diagnostic tool used by respiratory care professionals to assess overall physical condition of COPD patients).

In our view, these results seem to indicate that COPD patients who are in better pre-flight aerobic conditioning are less likely to experience significant shortness of breath when traveling by air.

While the researchers offered no recommendations for improving air travel experience for COPD patients in their paper, we think their results suggest a few proactive steps for those who would like to travel by air but have decided against it in the past because of anxiety related to a potential shortness of breath episode:
  1. Begin and maintain an exercise program 6-8 weeks prior to flying. Many COPD research studies have conclusively demonstrated that a regular program of aerobic and strength training exercise (the foundations of the COPD treatment known as pulmonary rehabilitation) does reduce perceived shortness of breath and does improve physical stamina, strength and endurance. If you have Stage II or Stage III COPD, ask your doctor for a referral to a pulmonary rehabilitation program in your area. Alternatively, if you can’t gain entry to a pulmonary rehab program, ask your doctor to recommend an exercise program appropriate for your particular circumstance. To learn more about our recommended exercise program for COPD patients, smokers and those who suffer from chronic shortness of breath, consider purchasing our Breathe Better for Life guidebook and companion CD-ROM, www.breathebetterforlife.com. We’ve patterned our program based on guidelines published by the American Thoracic Society, European Respiratory Society and the American College of Sports Medicine.
  2. Learn and practice the pursed-lips breathing technique leading up to the flight – and use this helpful breathing technique in-flight if you start to feel uncomfortable. This technique helps you clear old/used air out of your lungs in order to accommodate more new, oxygenated air. While a more robust description of the pursed-lips breathing technique and narrated pictorial demonstration are included on our Breathe Better for Life CD-ROM, we have posted a brief description of the technique on our Resplenish web site that you can access by clicking here. Resplenish is our new respiratory support nutritional supplement intended to help reduce inflammation/oxidative stress and improve exercise tolerance.
  3. Consider increasing your intake of antioxidants for at least 6-8 weeks prior to traveling to help reduce inflammation/oxidative stress. Numerous respiratory health-focused studies have been published over the past decade examining the anti-inflammatory properties of a range of antioxidants given that inflammation is believed by pulmonary researchers to be caused by an imbalance between pro-oxidative and anti-oxidative molecules. To read more about what causes inflammation and how antioxidants can help, click here to read our inflammation-related article “War of the Worlds in your lungs” on our Resplenish web site.
  4. Review our checklist recommendations for other COPD patient pre-flight preparations excerpted from the Breathe Better for Life CD-ROM by clicking here. Though many of these recommendations are for COPD patients who utilize supplemental oxygen, a number of the checklist items are useful to non-oxygen using COPD patients. 
As always, please consult your physician prior to following these recommendations to ensure they are appropriate for your particular situation. Additionally, if you do decide to plan a trip involving air travel, it is advisable to discuss your travel plans with your physician prior to your departure date to determine whether your specific health status warrants special considerations.

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