Golan Y, Onn A, Villa Y, et al. Arch Intern Med. 2002;162:2421–2426
Purpose of the Study.
Exacerbation of asthma during travel to remote regions may lead to devastating consequences. The course of asthma in travelers and the risk factors for disease exacerbation during travel have not been studied. The authors screened 5835 consecutive travelers and identified 203 patients with asthma. Before travel, all enrollees were assessed for presumed risk factors for asthma exacerbation by means of an interview and an exercise test combined with spirometry. After travel, data regarding travel characteristics and asthma severity were recorded by means of a structured telephone interview.
The 203 enrollees visited 56 countries for a median duration of 13 weeks, 147 were engaged in high-altitude trekking, and 88 had asthma attacks. Among these, 40 reported worsening asthma during travel, 32 experienced the worst asthma attack ever, and 11 reported a life-threatening asthma attack. Two independent risk factors for attacks during travel were identified: frequent use (≥3 times weekly) of inhaled bronchodilators before travel (relative risk [RR]: 3.35; 95% confidence interval [CI]: 1.75–6.39) and participation in intensive physical exertion during treks (RR: 2.04; 95% CI: 1.04–3.98). When both risk factors were present, the RR for asthma attacks increased to 5.52 (95% CI: 2.81–10.84).
Asthma frequently worsens during travel and should not be ignored as a potentially life-threatening condition requiring pretravel consideration. Asthmatic travelers who frequently use inhaled bronchodilators before travel or participate in intensive trekking during travel are at increased risk to develop asthma attacks. Therapy should be intensified to achieve better disease control; intensive trekking should be discouraged.
What really impressed me is that these travelers took vacations for a “median duration of 13 weeks.” Who’s at home doing all the work while these guys are out trekking for months at a time? It would appear that the combination of poorly controlled asthma (ie, frequent bronchodilator use) combined with the heavy exertion during treks was a nasty combination for inducing attacks of asthma. It would also seem that in anticipation of travel involving heavy exertion such as high altitude treks, asthma control really needs to be tightened up or these patients might be (and you knew this was coming) “too loose to trek.”