Arterial oxygen partial pressure and adverse health effects in COPD at altitude

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Importance: Patients with chronic obstructive pulmonary disease (COPD) experience low partial pressure of arterial oxygen (PaO2) and altitude-related adverse health effects (ARAHE) when travelling to high altitude. We analyzed altitude-related PaO2 and ARAHE in patients with COPD. Objective: To estimate PaO2 in relation to altitude and ARAHE in COPD. Data Sources: A systematic search of PubMed and Embase from inception to May 2021. Study Selection: Peer-reviewed prospective studies in COPD providing arterial blood gases within <3 days at altitude >1500m. Data Extraction and Synthesis: Study characteristics were extracted and risk estimates calculated from individual data. Estimates were pooled using random-effects meta-analysis. Main Outcomes and Measures: Relative risk estimates and 95% confidence intervals for the association between PaO2 and altitude in patients with COPD. Results: Seven studies suitable for quantitative analysis were identified. Data from 233 (45.2% female) patients with COPD exposed to altitudes up to 3100m were available. A 1000m altitude gain was associated with a mean PaO2–decrease of 0.81kPa (95%CI, 0.73 to 0.89; X2=25.61, I2=84.4%, P<0.001). In multivariate regression analysis, COPD severity and baseline PaO2 were independent predictors of PaO2 at altitude, whereas age and gender were not. 37.8% of patients experienced ARAHE while older age, female sex, COPD severity, baseline PaO2 and altitude reached were independent predictors of ARAHE (area under the curve: 0.9275, P<0.001). Conclusions and Relevance: This study provides estimates of PaO2 and risk of ARAHE in patients with COPD at altitudes of many tourist destinations. The findings may contribute to improve patient care.

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