What to Keep in Mind When Traveling to Higher Altitudes with COPD

Whether you’re flying or hiking through mountains, higher altitudes can worsen COPD symptoms. Here’s how to prepare to enjoy your trip with fewer unwanted side effects.

Travel can boost your mental health and help you make lifelong memories and connect with others. Sometimes, a trip will literally take you to new heights if it involves air travel or visiting mountainous regions like Colorado. But these higher altitudes can increase the symptoms of chronic obstructive pulmonary disease (COPD).

As the altitude increases, you may find breathing difficult, which is understandably frightening. Exhaustion may also set in as you feel like the world is spinning, leaving your stomach tumbling. If you’ve never experienced these potential side effects of high altitude travel with COPD, just reading these words may have you removing plane tickets from your cart.

Consider reconsidering.

“While COPD can present some challenges, with proper planning and management, you can safely navigate higher altitudes and have a wonderful trip,” said Emanuele Santomauro, MD, a pulmonologist at Hackensack Meridian Health.

This guide will help you map out your high altitude travels so you can enjoy the ride (or hikes).

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How does high altitude affect COPD?

There’s science behind high altitude’s effect on COPD.

We often think of ourselves as breathing oxygen, but we actually breathe a mixture of air that’s typically 21% oxygen. That number stays the same whether you’ve just reached a mountain’s summit or you’re relaxing at sea level.

What changes? Air pressure. The decreasing air pressure at high altitudes means there’s less oxygen available for your lungs, so they have to work harder to breathe the same amount of oxygen, said Daniel Meza, MD, a pulmonologist at Northwestern Medicine.

As you know, COPD makes breathing more challenging — and your life is at risk when your body doesn’t have enough oxygen to work. It’s also uncomfortable. Santomauro said high altitude travel may bring on feelings such as:

• breathlessness, even if you’re moving slowly
• fatigue, which makes it hard to participate in activities
• headaches because of difficulties getting enough oxygen
• dizziness, especially when you’re standing
• swelling, particularly in your legs and ankles, because of fluid buildup
• gastrointestinal discomfort, including nausea

According to a 2021 research article, high altitudes can also increase the risk of the following conditions in people with COPD:

• heart conditions
• pulmonary hypertension (high blood pressure in your lungs)
• sleep disorders

Tips to prepare for high altitude travel

One 2020 survey of nearly 5,000 people living at higher altitudes (2,100 to 4,700 meters) suggests that COPD is a public health challenge. But doctors say that even spending short amounts of time at high altitudes can pose health risks.

Some practical tips can help you reduce the side effects and dangers of high altitude travel and feel more empowered.

I spoke with Meza and two other pulmonary experts about how planning your trip — from your pace to your packing list — can help you fully enjoy yourself.

Talk with your doctor

You may have a shelf full of guidebooks on your destination’s top attractions, hotels, and restaurants. But a trusted doctor can guide you by helping you understand the current stage of your COPD, which matters.

The authors of a 2012 case report suggest that people with moderate to severe COPD are more likely to have difficulty while flying.

Bindu Akkanti, MD, from the division of pulmonary, critical care, and sleep medicine at the University of Texas Health Science Center and McGovern Medical School in Houston, said your healthcare team can help you determine the severity of your COPD through tests such as:

• a 6-minute walk test
• a CT scan of your lungs
• a COPD assessment test, which can help them understand your baseline symptom burden

This information can help your doctor find the best ways to keep you safe and comfortable.

Consider supplemental oxygen

One useful tool might be supplemental oxygen, if you’re not already using it. Akkanti explained that, depending on your oxygen saturation levels at home, your doctor may write you a prescription and a letter confirming that you need it.

You may have to undergo a hypoxia altitude simulation test (HAST), which mimics the pressure changes you might experience during a flight. Your doctor can measure how much extra oxygen you need to help you breathe normally.

The HAST will help your doctor figure out how much oxygen you’ll need to take with you on your flight. You’ll either be able to rent a portable oxygen concentrator or pay a fee to use an airline’s portable oxygen concentrator.

While more research is needed, a 2021 research article suggests that using oxygen therapy while you’re sleeping and while in flight could be helpful.

Meza added that needing supplemental oxygen doesn’t necessarily mean you can’t participate in certain activities, such as hiking. Portable oxygen tanks or oxygenators travel well.

Pro tip: “If you have an electric oxygenator, you want to make sure you have enough batteries or will have a place to plug it in to charge,” Meza said.

Pack for success

Consider adding some other items to your traveling COPD toolkit. Santomauro suggested adding the following items to yours:

• a peak flow meter to monitor lung function and changes that may signal a need for medical care
• any inhalers and medications that you regularly use and anything prescribed for altitude sickness
• a pulse oximeter, which measures your blood oxygen levels and can help you evaluate how higher altitudes are affecting you
• comfortable shoes and clothing to make movement and exploration easier
• emergency contact information, such as your doctor’s phone number and the local emergency number (if it’s not 911)

Akkanti also suggested bringing a face mask to lower your risk of catching a virus or infection, such as the SARS-CoV-2 virus, which causes COVID-19.

Customize your itinerary

Of course, part of pre-trip planning involves what you’ll be doing during your travels. The experts I spoke with suggested:

• changing altitudes gradually
• easing into physically challenging activities
• taking medications as prescribed
• staying hydrated and well nourished
• moving around during long flights or car rides to reduce the risk of blood clots
• taking frequent breaks and listening to your body

Santomauro suggests gradually moving to higher altitudes to help your body adjust to the changes. An older 2009 research review suggests limiting elevation changes to less than 500 meters per day once you’re above 2,500 meters.

Santomauro also recommended giving your body a day or two to adjust to the new altitude before participating in activities that are physically difficult. Scheduling time to eat nourishing meals and sipping water throughout the day can prevent energy lags and dehydration, which can also worsen symptoms.

Finally, packed itineraries are tempting in today’s go-go-go world, but it’s also important to schedule rest — and to tune in to your body and take a break when you need it, even if it’s not on the itinerary.

“Don’t push yourself too hard,” Santomauro said.

When to seek medical care

Listening to your body means knowing how to spot a red flag and when to find quick medical care. Meza said it’s critical to take this step if you start feeling new or worsening symptoms such as:

• shortness of breath
• chest tightness
• coughing
• fevers
• headaches that don’t go away with the help of acetaminophen (Tylenol)
• dizziness or lightheadedness during challenging physical activity

Additionally, Meza said to get medical help if your oxygen saturation is consistently below 88%, if you run out of home oxygen, or if the battery in your concentrator runs out.

Takeaway

Higher altitudes can worsen COPD symptoms and can even pose potentially life threatening health risks, including shortness of breath, sleep issues, and nausea. But that doesn’t mean you have to rule out taking a flight or visiting a high altitude region.

Talking with your healthcare team can help you determine how severe your COPD is now and customize your approach. For instance, tools such as supplemental oxygen can keep you comfortable and safe when traveling.

When possible, consider gradually moving up in altitude and pacing yourself throughout your travels by scheduling breaks and listening to your body.

Even the best-laid plans may need changing if you start experiencing symptoms. That’s OK. Seek medical care if you need it — and remember that you didn’t carve your original itinerary in stone.