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

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

doi:10.1186/s13104-017-2386-2

Abstract

BackgroundAir 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.MethodsThirty 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.ResultsFour 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.ConclusionsExercise 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)

Highlights

Air travel may imply a health hazard for patients with cystic fibrosis (CF) due to hypobaric environment in the aircraft cabin
From January 2006 to December 2008, all adult CF patients referred to the National Center for Cystic Fibrosis at Oslo University Hospital, Norway for comprehensive assessment, and who were in a stable phase of their disease, were invited to participate in this cross-sectional hypoxia-altitude simulation test (HAST) study
Fifteen patients (50%) had a forced expiratory volume after 1 s (FEV1) < 50% of predicted, 16 patients (53%) had a SpO2 sea level (SL) < 95%, and six patients (20%) had a arterial oxygen tension (PaO2) SL < 9.3 kPa, cut-off values which have all been suggested as criteria for supplemental oxygen during air travel [3]

Summary

Introduction

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. Due to the hypobaric environment in the aircraft cabin, air travel may imply a health hazard for CF-patients, most of them suffering from chronic pulmonary disease. The ambient oxygen partial pressure inside the aircraft cabin during commercial air travel is reduced, corresponding to an altitude of 2438 m (8000 ft) at maximal. Guidelines concerning pre-flight evaluation of patients with pulmonary disease have suggested various screening variables as normative, such as oxygen saturation at sea level and spirometric values [2,3,4]. Administration of supplemental oxygen during flight is advised if PaO2 drops below 6.6 kPa during the test [3, 4]

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