Air travel for patients with chronic obstructive pulmonary disease: a case report.

CASEREPORT A 63-year-old female smoker (80 pack years) travelled from Athens, Greece to Amsterdam in The Netherlands. She had been diagnosed with hypertension, moderate COPD, mild cardiac failure, and severe osteoarthritis in the left knee. Thirty minutes after take-off she started to experience severe dyspnea, without tachycardia or chest pain, that required immediate medical attention. After administering oxygen at 2 L/min, the symptoms slowly improved and she arrived safely in Amsterdam. The patient had experienced similar symptoms during other flights in the past. Her GP thought that she should be examined by cardiologists and pulmonologists to assess the possible need for in-flight oxygen supplementation. The cardiologist conducted a full clinical examination, as well as an electrocardiogram and heart ultrasound, and decided that, as the cause of the oxygen desaturation during flight was not from her heart, she should be referred to pulmonologists for further assessment. The pulmonologists conducted spirometry and an arterial saturated oxygen (SaO2) test. The results were: a forced expiratory volume in 1 second (FEV1) of 60% predicted; an FEV1/forced vital capacity (FVC) of 0.65; and aSaO2 of 94%. The patient did not perform a 6-minute walking distance test (6MWT) as this was not possible due to the severe osteoarthritis of her left knee. As a hypoxia inhalation test was not available, even in the tertiary hospital, the pulmonologist said that the patientwouldprobably need in-flight oxygen supplementation. This was based only on the available calculations (equations) for determining the need for oxygen supplementation in flight. The pulmonologist did not give precise advice to the patient and, as a result, the patient experienced the same dyspnea during flight as she had done before. As the patient had experienced severe dyspnoea in previous flights, should her doctors be more careful and prepare her journey in a safer way?