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Asthma in Adventure Travelers
A Prospective Study Evaluating the Occurrence and Risk Factors for Acute Exacerbations
Yoav Golan, MD;
Amir Onn, MD;
Yael Villa, PhD;
Yoav Avidor, MD;
Shmuel Kivity, MD;
Stephen A. Berger, MD;
Itzhak Shapira, MD;
Yoram Levo, MD;
Michael Giladi, MD,MSc
Arch Intern Med. 2002;162:2421-2426.
Background 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.
Methods We 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.
Results 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).
Conclusions 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.
From the Unit of Infectious Diseases and Travel Advisory Clinic (Drs Golan, Avidor, Berger, Shapira, and Giladi), Division of Pulmonary and Allergic Diseases (Drs Onn and Kivity), and Department of Medicine "T" (Dr Levo), Tel Aviv Sourasky Medical Center, and Department of Biostatistics, Sackler Faculty of Medicine, Tel Aviv University (Dr Villa), Tel Aviv, Israel. Dr Golan is now with the Division of Geographic Medicine and Infectious Disease, New England Medical Center, Boston, Mass.
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