Do lung disease patients need supplemental oxygen at high altitude?

As medical care and the quality of life for patients with lung disease improve, many of these individuals may engage in various forms of travel, including, possibly, travel to high altitude. Because the hypobaric hypoxia at high altitude may cause severe hypoxemia or impaired exercise tolerance in these patients, clinicians may be asked to assess whether they should use supplemental oxygen during their planned sojourn. This review considers this question in greater detail. After considering how the issue is approached in commercial airplane flight, we consider changes in oxygenation in lung disease patients in ambient hypoxia, the complications associated with such changes, tools for predicting the degree of hypoxemia at high altitude and important logistical issues associated with traveling with supplemental oxygen. The review concludes by providing tentative recommendations for assessing which patients should travel with supplemental oxygen. Patients already on supplemental oxygen at baseline should increase their flow rates at high altitude; patients with sufficiently severe disease who are not on such therapy should undergo pretravel assessment to determine the likely degree of hypoxemia at high altitude, with hypoxia altitude simulation testing being the preferred modality for this assessment. Those patients who develop symptomatic hypoxemia during such testing should travel with supplemental oxygen; those who remain asymptomatic or maintain adequate oxygenation may travel without oxygen, but they should have plans to monitor symptoms and oxygen saturation following arrival and arrange for oxygen therapy if necessary.