Table 2 Disease specific assessment and treatment options of respiratory patients travelling to terrestrial moderate and high altitude
Disease | Assessment | Treatment |
|---|---|---|
COPD | Disease severity: spirometry and TLCO Exclude exacerbation Check treatment adherence 6MWD Consider HCT ± submaximal exercise test (if baseline SpO2 92–95%) Consider screening for secondary PH by cardiac ultrasonographya | Advise patient about physical activity at moderate to high altitude: submaximal physical activity is generally well tolerated Take rescue medication Discuss feasibility of supplemental oxygen when positive HCT (PaO2< 50 mmHg) If co-existent PH: see recommendations below |
Asthma | Disease severity: spirometry Exclude exacerbation Check treatment adherence Consider screening for EIB by bronchoprovocation test (high intensity exercise test or EVH test) Consider HCT ± submaximal exercise test (if baseline SpO2 92–95%) | Provide written action plan in case of exacerbation Take rescue medication Avoid allergen exposure Advise patient to protect nose and mouth (scarf) to warm and humidify air Treat comorbid rhinitis, GER Consider pre-exercise/on demand short acting bronchodilator ± ICS |
Sleep apnoea | Check CPAP device Check for underlying comorbid disease and consider more specific testing accordingly (e.g. COPD) Baseline nocturnal oximetry HCT ± submaximal exercise test (if baseline SpO2 92–95%) | Sleep hygiene (sufficient and regular sleep) Continue CPAP device (auto-pilot set) Consider combination therapy with acetazolamide (2–3 × 250 mg/day) on top of CPAP device Acetazolamide alone (2–3 × 250 mg/day) better than no CPAP Consider mandibular advancement device if CPAP refused or unfeasible |
Bullous/cystic lung disease | Consider HCT ± submaximal exercise test (if baseline SpO2 92–95%) | Advise LAM patients about increased pneumothorax risk Discuss supplemental oxygen when positive HCT (PaO2 < 50 mmHg) |
Pneumothorax | If recent history of pneumothorax, perform chest X ray | Postpone travel 2 weeks following radiographic resolution In case of recurrent pneumothorax, pleurodesis is recommended before travel |
Pulmonary hypertension group I and IV | Disease severity: spirometry and TLCO 6MWDt Baseline cardiac ultrasonography Consider HCT ± mild submaximal exercise test (if baseline SpO2 92–95%) | Discuss supplemental oxygen if: Severe hypoxaemia at sea-level (PaO2 < 60 mmHg) Positive HCT (PaO2 < 50 mmHg) WHO functional class III to IV |
Interstitial lung disease | Disease severity: spirometry and TLCO 6MWD Consider HCT ± submaximal exercise test (if baseline SpO2 92–95%) Consider screening for secondary PH by cardiac ultrasonographya | Discuss supplemental oxygen when positive HCT (PaO2 < 50 mmHg) |