Bob Messenger, RRT, CPFT, FAARC
Is traveling to high altitudes a concern—perhaps vacationing in Colorado—when I have COPD? Is there something I should bring or do while I’m there? How do I prepare?
As we go up in altitude, the composition of air remains the same (20.9% oxygen and 79% nitrogen), but the thickness of the air reduces. In other words, there are fewer air molecules in any given space. It’s this later part, the thinning of the air, which makes breathing more difficult at higher altitudes. Even a young, healthy person who normally lives at lower altitudes will experience some degree of shortness of breath or at least a decrease in their ability for activity when they first arrive at a high altitude destination. So, we can all expect an immediate effect of some sense of breathlessness.
Our bodies naturally adapt, however. Usually our bodies will produce more red blood cells so that it can carry more oxygen—this is the so-called thickening of the blood. However, with advanced lung disease there may be a problem with allowing the blood to thicken.
One of the ways that we deal with lung disease is to produce more red blood cells in order to carry more oxygen to the rest of the body. This happens to people regardless of where they live. If a person with COPD lives in New York City (which is low altitude) and already has a relatively high amount of red blood cells, they could have even more red blood cells produced if they went to Denver. The problem with this is that as more red blood cells are added, the blood becomes thicker. Think of the difference between water and oil. It’s much easier to pump water through a pipe than it is to pump oil through a pipe, and it’s easier for the heart to pump relatively thin blood than it is to pump thicker blood.
So what can be done? There are several options.
Slowly adjust to the higher altitude. In other words, take your time and slowly make your way to the higher altitude over the course of several days. Unfortunately, most of the time, this is not a very practical strategy.
Increase the setting on your delivery system if you use oxygen. At first you might think that this will increase your total oxygen delivery, but that is not necessarily true. Remember, the problem is that the amount of oxygen you are getting is reduced because of the higher altitude and the thinner air. Boosting your oxygen setting slightly higher will function to make up the difference. Of course before making any changes to your oxygen setting you should first speak with your physician and tell him or her where you are planning on going.
Talk to your doctor. They may recommend that you get a pulse oximeter. A pulse oximeter can tell you how much of your red blood cells are actually carrying oxygen. You and your doctor can decide on a target value, such as 90%. If your blood oxygen saturation level falls below your target value, you can simply adjust your oxygen setting to the next higher level and repeat the measurement. Just remember that within hours your body will be producing more red blood cells to help distribute oxygen. So, within one or two days, you may find that even though your blood oxygen saturation level is lower than you may like, your sensation of shortness of breath may start to go away.
Bob Messenger is a registered respiratory therapist and manager of respiratory education for Invacare Corporation. Bob's research has resulted in over two dozen publications in trade and peer-reviewed journals and he lectures on a variety of respiratory and sleep related topics throughout the US and Canada.