Hypoxic Challenge Testing for Fitness to Fly with Severe Asthma
INTRODUCTION: Commercial airline travel poses a recognized risk to patients with respiratory disease, including in those with asthma. Hypoxic challenge testing (HCT) is typically employed to mitigate this risk by dictating in-flight oxygen requirement.
METHODS: The role of HCT has not been formally studied in patients with severe asthma and we therefore evaluated HCT assessment in a cohort of patients with severe asthma (N = 37).
RESULTS: Over half (57%) of patients had a positive HCT. Baseline oxygen saturation (Spo2) was poorly predictive of a recommendation for supplementary oxygen in flight; two-thirds of those deemed to require oxygen had a baseline Spo2 > 95%. A combination of any two of: Pao2 ≤ 10.5 kPa, FEV1 ≤ 60% predicted, and PEF ≤ 350 L ยท min−1 predicted the need for in-flight oxygen with a sensitivity of 89% and a specificity of 69%. Furthermore, no patient with an Spo2 > 95% and FEV1 > 85% predicted had a positive HCT.
CONCLUSION: Overall, the findings indicate that HCT should be considered for all patients with severe asthma, regardless of resting oxygen saturation level.
George PM, Orton C, Ward S, Menzies-Gow A, Hull JH. Hypoxic challenge testing for fitness to fly with severe asthma. Aerosp Med Hum Perform. 2016; 87(6):571–574.
METHODS: The role of HCT has not been formally studied in patients with severe asthma and we therefore evaluated HCT assessment in a cohort of patients with severe asthma (N = 37).
RESULTS: Over half (57%) of patients had a positive HCT. Baseline oxygen saturation (Spo2) was poorly predictive of a recommendation for supplementary oxygen in flight; two-thirds of those deemed to require oxygen had a baseline Spo2 > 95%. A combination of any two of: Pao2 ≤ 10.5 kPa, FEV1 ≤ 60% predicted, and PEF ≤ 350 L ยท min−1 predicted the need for in-flight oxygen with a sensitivity of 89% and a specificity of 69%. Furthermore, no patient with an Spo2 > 95% and FEV1 > 85% predicted had a positive HCT.
CONCLUSION: Overall, the findings indicate that HCT should be considered for all patients with severe asthma, regardless of resting oxygen saturation level.
George PM, Orton C, Ward S, Menzies-Gow A, Hull JH. Hypoxic challenge testing for fitness to fly with severe asthma. Aerosp Med Hum Perform. 2016; 87(6):571–574.
Keywords: altitude; asthma; flight; hypoxia; oxygen
Document Type: Short Communication
Affiliations: Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
Publication date: 01 June 2016
- This journal (formerly Aviation, Space, and Environmental Medicine), representing the members of the Aerospace Medical Association, is published monthly for those interested in aerospace medicine and human performance. It is devoted to serving and supporting all who explore, travel, work, or live in hazardous environments ranging from beneath the sea to the outermost reaches of space. The original scientific articles in this journal provide the latest available information on investigations into such areas as changes in ambient pressure, motion sickness, increased or decreased gravitational forces, thermal stresses, vision, fatigue, circadian rhythms, psychological stress, artificial environments, predictors of success, health maintenance, human factors engineering, clinical care, and others. This journal also publishes notes on scientific news and technical items of interest to the general reader, and provides teaching material and reviews for health care professionals.
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