Lung Disease And Flying

"Pre-Flight Testing Urged for All Travelers With Restrictive Lung
Disease"

Would this BE because of their PREdisposal to too many red blood
cells / polycythemia ?
Lung disease is accompanied by erythrocytosis / polycythemia /
increased red blood cells.
The lung disease induced blood cell production is NOW increased even
more / red blood cell production / low cabin pressure .. leads to
increased chance of .. death / stroke .. ?

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Pre-Flight Testing Urged for All Travelers With Restrictive Lung
Disease

(Reuters Health) Jun 24 - All patients with severe extrapulmonary
restrictive lung disease should undergo a hypoxic challenge test prior
to air travel, according to a report in the June issue of Thorax.

The authors of the paper, led by Dr. M. W. Elliott from St. James's
University Hospital, Leeds, UK, note that according to British
Thoracic Society guidelines, travelers with respiratory disease do not
need to be assessed for a need for supplemental in-flight oxygen if
their resting oxygen saturation is greater than 95%. These guidelines,
the authors say, are based "on anecdotal evidence and little data."

To assess the appropriateness of the British guidelines, the
researchers administered hypoxic challenge tests to 19 adults with
kyphoscoliosis or neuromuscular disease, all of whom were at risk for
nocturnal hypoventilation and 15 of whom used home ventilators while
sleeping.

All subjects completed the challenge with no adverse effects, although
testing was aborted in 5 patients when oxygen saturation fell below
85%. Three of these 5 had resting oxygen saturation levels above 95%.

Based on the results of the hypoxic challenge tests, supplemental in-
flight oxygen would be recommended for 50% of the patients with
resting oxygen saturation above 95% (who would not be deemed by the
British Thoracic Society guidelines to require in-flight oxygen) and
71% of patients with borderline baseline oxygen saturation (92-95%).

Only 4 of the 19 patients in this study would definitely not require
in-flight oxygen based on the test result, the researchers note.

There was no consistent relationship between the change in partial
pressure of arterial oxygen (PaO2) and the change in partial pressure
of arterial carbon dioxide (PaCO2) during hypoxic challenge, the
investigators say.

"This finding suggests that all patients with severe extrapulmonary
restrictive lung disease should undergo assessment with hypoxic
challenge test prior to air travel," the authors conclude. "The study
confirms that even patients with a resting saturation of 95% can
desaturate significantly during hypoxic challenge."

"A decision as to whether it is safe for a patient to fly should be
made by an experienced clinician...based on a number of factors, which
should include previous travel experience, the patient's overall
condition, and the results of a hypoxic challenge test," they add.

Thorax 2009;64:532-534.
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