Self-monitoring symptoms and pulse oximetry to predict imminent altitude illness in patients with chronic obstructive pulmonary disease.
Michael Furian, Aurelia E Reiser, Maamed Mademilov et al.
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In 30 seconds
This clinical trial assessed whether structured self-monitoring (SSM) of symptoms and pulse oximetry could predict subsequent altitude-related adverse health effects (ARAHE) in 153 lowlanders with moderate to severe COPD, without chronic respiratory failure, who travelled to 3100 m. ARAHE occurred in 116 patients (76%); SSM was positive in 55 (36%). Its diagnostic accuracy was 0.65 (95%CI 0.58 to 0.72), and its positive predictive value was 91% (95%CI 80 to 97), while its negative predictive value was 33% (95%CI 24 to 43). Exploratory nocturnal oximetry improved sensitivity and diagnostic accuracy.
Key findings
- ARAHE occurred in 116 of 153 patients (76%) during the altitude sojourn.
- SSM had diagnostic accuracy of 0.65 (95%CI 0.58 to 0.72); its positive predictive value was 91% (95%CI 80 to 97).
- The negative predictive value of SSM was 33% (95%CI 24 to 43), so a negative result did not reliably indicate low risk.
- In exploratory analyses, adding nocturnal pulse oximetry improved sensitivity from 43% to 73% and increased the concordance statistic to 0.80.
Why it matters
Altitude travel can be associated with frequent adverse health effects in people with COPD. These findings suggest that symptom and oxygen-saturation monitoring may help identify patients at increased risk of imminent events, but a negative self-monitoring result cannot provide reassurance that risk is low. The exploratory nocturnal oximetry result may inform further evaluation of monitoring approaches.
What to keep in mind
The study assessed patients during a specific rapid ascent to 3100 m and a 2-day stay; the findings may not generalise to other travel conditions. The nocturnal oximetry analysis was exploratory.