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- Title
Effect of natural oxygen enrichment at low altitude on oxygen-dependent patients with end-stage lung disease.
- Authors
Kramer, Mordechai R.; Springer, Chaim; Berkman, Neville; Bar-Yishay, Ephraim; Avital, Avraham; Mandelberg, Avigdor; Effron, Dow; Godfrey, Simon; Kramer, M R; Springer, C; Berkman, N; Bar-Yishay, E; Avital, A; Mandelberg, A; Effron, D; Godfrey, S
- Abstract
<bold>Objective: </bold>To assess the effect of lowering altitude to that of the lowest place on earth (Dead Sea) on arterial oxygenation and exercise performance in patients with hypoxemia and end-stage lung disease.<bold>Design: </bold>A cohort of 10 patients.<bold>Setting: </bold>Pulmonary function laboratories in Jerusalem, Israel, and at the Dead Sea.<bold>Patients: </bold>10 patients with end-stage lung disease who were receiving long-term oxygen therapy. The 4 males and 6 females were 12 to 77 years old. Four patients had chronic obstructive pulmonary disease; 2 had cystic fibrosis; 3 had pulmonary fibrosis; and 1 had pulmonary hypertension (thromboembolic). Mean forced vital capacity was 1.54 L (54% of predicted value) and mean forced expiratory volume in 1 second was 0.85 L (35% of predicted value).<bold>Measurements: </bold>Spirometry, blood gas analysis, progressive exercise testing, and sleep oximetry were done in Jerusalem (altitude, 800 m above sea level; barometric pressure, 696 mm Hg); the same measurements were done 6 days after arrival at the Dead Sea (altitude, 402 m below sea level; barometric pressure, 800 mm Hg) and then 7 to 14 days later in Jerusalem.<bold>Results: </bold>Arterial oxygenation increased from a median partial pressure of arterial oxygen of 51.6 mm Hg in Jerusalem to 67.0 mm Hg at the Dead Sea, an increase of 15.2 mm Hg (95% CI of paired difference, 4.1 to 20.4 mm Hg; P = 0.001). Partial pressure of arterial carbon dioxide increased from a median of 43.2 to 45.9 mm Hg, an increase of 2.7 mm Hg (CI, 0.5 to 6.4 mm Hg; P = 0.004), with a borderline significant change in the alveolar-arterial gradient. Arterial oxygen saturation increased from a median of 87.7% to 92.8%, a change of 4.8% (CI, 1.9% to 9.8%; P = 0.003). Exercise performance also improved as maximum oxygen uptake increased from a median of 827 mL/min to 1056 mL/min, an increase of 203 mL/min (CI, 54 to 388 mL/min; P = 0.006). Sleep oximetry also improved as median arterial oxygen saturation measured during sleep increased from 85% to 90%, a change of 5% (CI, 2% to 7%; P = 0.005), and percentage of sleep time with an oxygen saturation rate of 90% or more increased from a median of 24% to 73%, a change of 49% (CI, 20% to 87%; P = 0.02). No change in spirometry was noted. All patients felt less dyspneic and reported improved functional capacity with reduced need for oxygen.<bold>Conclusion: </bold>Descent to low altitude can improve arterial oxygenation, exercise performance, and sleep oximetry and consequently the quality of life in patients with hypoxemia and advanced lung disease.
- Subjects
ALTITUDES; HYPOXEMIA; LUNG diseases; THERAPEUTICS
- Publication
Annals of Internal Medicine, 1994, Vol 121, Issue 9, p658
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-121-9-199411010-00005