High Altitude

If you have chronic obstructive pulmonary disease (COPD) and like to travel, chances are that you already know that air quality conditions at higher elevations can make breathing more difficult. Your body literally needs to work harder to take in the same amount of oxygen as it does closer to sea level. More than several days of exposure to high-altitude conditions can also cause adaptations to the heart and kidneys. 

Depending on the severity of your COPD symptoms, you may have more health problems and/or need to supplement your breathing with oxygen at high elevations, particularly above 5,000 feet. Breathing at higher altitudes might be especially difficult if you have COPD and other diseases including high blood pressure, heart disease, obesity, and/or diabetes.

Typical air pressure on commercial air flights is equivalent to 5,000 to 8,000 feet above sea level. Chronic obstructive pulmonary disease patients whose resting blood oxygen concentration is already low (PaO2 < 69mm Hg) at sea level will require supplementary oxygen to avoid oxygen deficiency. If you are bringing your own oxygen onboard, you need to make prior arrangements to do so.  

What Is High Altitude?

The air at higher elevations is colder, less dense, and has fewer oxygen molecules; therefore, in order to get the same amount of oxygen as you would at a lower elevation, you need to take additional breaths.

  • High Altitude (1,500m – 3,500m / 4,921 – 11,483 ft.)
  • Very High Altitude (3,500m – 5,500m / 11,483 – 18,045 ft.)
  • Extreme Altitude (greater than 5,500m or 18,045 ft.)

Altitude Sickness

People without respiratory disease can develop acute mountain sickness (AMS) when adjusting to the changes in air quality at higher elevations, especially if they are physically exerting themselves; as many as 53 percent of travelers become affected by AMS at elevations higher than 8,000 feet. If left untreated, or if they cannot descend to a lower elevation, altitude sickness can progress to high-altitude cerebral edema (HACE), or fluid in the lungs, and/or high-altitude pulmonary edema (HAPE), or fluid/swelling of the brain. 

Acute mountain sickness can be mild to severe. Its early symptoms can include dizziness, fatigue, lightheadedness, sleepiness, headache, nausea, vomiting, rapid pulse/heartbeat, and shortness of breath. If untreated, more serious symptoms can develop, eventually leading to confusion, bluish skin (cyanosis, a result of less oxygen in the blood and tissues), chest tightness, cough, and decreased consciousness. Without supplemental oxygen, AMS can result in fluid retention in the lungs or around the brain, coma, or death. Longer exposure to high-altitude conditions (several weeks or more) can cause sub-acute mountain sickness and/or chronic mountain sickness.    

Talk With Your Doctor

Discuss your travel plans and COPD symptoms with your doctor. Being prepared before you travel is critical. Your doctor can explain altitude sickness, how it might affect your breathing, and how you can be better prepared with treatment options that may include additional medications and/or supplemental oxygen. If you are concerned by how your COPD symptoms could become exacerbated by high-altitude conditions, your doctor can test your breathing at oxygen levels that are simulated to mimic those conditions. That test is called a high altitude hypoxemia measurement.

Relocating to Places of High-Altitude

People with COPD need to discuss with their doctors any considerations they may have for relocating their residency to a high-altitude area. Together you can assess the risks of such a move and the possible complications of your COPD symptoms.

In general, such a move is ill advised, as it often means a reduced quality of life for COPD patients. While it is impossible to know whether or not a person’s individual COPD symptoms will exacerbate due to changes in air quality, multiple studies have demonstrated that COPD patients living in higher altitudes have a higher mortality rate and die after a shorter duration of the disease.