This is regarding my father, 77 years old, is a patient of COPD. He is an ex-smoker for almost 40 years and has been suffering from a shortening of breath for the last few years but his situation got worse in the last year. He was prescribed with home Oxygen machine for at least 10-12 hours, nebulization on daily basis and few other medicines, he used to have swelling in his body and having difficulty urinating. Doctors prescribed him with diuretic medicine. A few months back, I took him to emergency and spent a night over there, later transferred to ICU (Intensive Care Unit) for almost a week, his situation gotten worse and doctors put him on a ventilator for 72 hours. He came okay and spent a few more days in ICU then transferred to a private room, spent a week in the hospital and discharged.
At home, his situation was on and off and not actually improving, now he was on 24/7 Oxygen machine and occasionally on BIPAP too, use to do suctions on suction machines under the supervision of a male nurse provided to him for 24/7, nebulization thrice a day but the situation was not improving much. A week ago, he was found unconscious and rushed to the emergency. Again put him on a ventilator for 48 hours and improving at a slower pace.
Being a daughter, I want the very best for my father and want advanced COPD treatment, available only in few countries called ’Endoscopic Lung Volume Reduction' treatment by introducing a small valve with minimally invasive surgery (within 20-30 minutes). I need your advice in this matter. I have uploaded the medical history report and the tests we have done here.
Welcome to icliniq.com.
Thanks for writing your query to me. I can understand your concern about your father. I have seen all the reports attached herewith (attachment removed to protect patient identity). Considering his general condition now, your concern of air travel is very important to analyze before you book tickets with the airlines. Also, it is not as simple as we think but with careful evaluation and guidance he maybe able to fly shorter destination flights.
Very important to remember that he is still recovering from bad respiratory failure and cardiac event. Also, still he is oxygen dependent at room temperature. Being hypertensive and recently hospitalized, it is advisable to avoid any travel at least for 6 weeks to prevent further complications. Fitness to fly for COPD patients need to comply a definitive pre-travel eligibility criteria and need necessary documentation from treating Pulmonologist.
During air travel in commercial flights, oxygen level falls considerably due to low cabin air pressure and we must supplement oxygen to prevent further hypoxemia and other complications. So it is advisable to keep checking oxygen saturation frequently. If the resting oxygen saturation is less than 92 %, he may require supplemental oxygen in-flight. But commercial flights generally dont allow to carry our oxygen cylinder but you can carry oxygen concentrator with prior confirmation from airline. Airline can provide supplemental oxygen if required during flight but it will be very costly and has to be booked well before in advance while booking tickets. So it is very important to take opinion of his treating Pulmonologist and do pre-flight evaluation if he is fit to fly or not.
Necessary medicines, inhalers and tablets need to be refilled before flying. Once he is fit to fly, while booking seats, consider seat neat toilet to avoid walking, frequently check oxygen saturation and avoid tea, coffee or any other drinks during air travel. Please make firm confirmation for all the concerns with the airlines before you book tickets. Do not forget to get fitness certificate and medical prescriptions from your doctor and carry them during air travel.
Uncontrolled Moderate to severe COPDInvestigations to be done:
Pre-flight Fitness evaluation
Hypoxic challenge test if available locally
Oxygen supplementation either by cylinder or Oxygen Concentrator
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Thanks for your answer, it is very helpful regarding his travel arrangements.
But I also ask you about the treatment for COPD patients, I know that Lung Volume surgery is available in many countries but it is quite invasive and new Endoscopic Lung Volume reduction treatment is available in some countries. In this treatment, the doctor creates an incision and inserts a plastic valve in the Bronchi/bronchioles to channelize the one-way flow of the air and prevent the backflow of the air.
Could you please suggest any treatment for him to recover from this worst situation. Please provide me some insight into the Lung Volume Reduction surgery, what are chances of improvement and risks? The big question is whether my dad is suitable for this surgery at his current state? Please give me some direction.
Welcome back to icliniq.com.
Endobronchial valve replacement therapy is non-surgical option for patients with advanced COPD. It improves exercise tolerance, lung function, and quality of life. It improves 5 year survival rate from 40 to 60%. But it is available in a very few centers and expert team is required to carry out the procedure. The procedure of bronchoscopic lung volume reduction therapy with endobronchial valve replacement is simple with no major complications. Approximately only 1 out of 10 patients with advanced emphysema are eligible for valve treatment as all patients does not fulfill eligibility criteria. So, it is very important to discuss the case well in advance with the doctor performing this valve replacement. He is the best judge to decide if Valve replacement is possible or not.
As discussed earlier, the general condition of your father is very critical at present. So it is advisable to continue with Oxygen Support and neutralization treatment now. Once he is able to wean off oxygen and symptoms have improved, you can discuss about further treatment with the concerned center. they will carry out necessary investigations and decide further plan.
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