Asthmatics with Altitude: Traveling with Asthma to Higher Elevations8 min read
Annie Sullivan views the world as her oyster. At just 27 years old, she has been to nearly every continent, having traveled to
Antarctica, through the high altitudes of the Andes Mountains of Cusco, Peru, down the Mekong River in Vietnam and Cambodia and through Egypt, Russia and the Galapagos Islands in Ecuador.
So far, she’s been to about 40 countries.
Sullivan caught the travel bug early in life, thanks to her family.
“I think I was about 7 when I went on a cruise to Alaska with my parents and three siblings. We’d taken other smaller trips before that, but that was the first time I really realized how different the world could be,” she says now.
“After that, I knew I wanted to see as much as I could in the time I had on this Earth.”
Not only did her family ignite her desire to see the world, they continued to fuel it.
“It helped that my parents love traveling and took us on amazing adventures. I guess you could say that once I started learning about different cultures, I just kept wanting to know more,” she says.
There was just one hitch to her aspiration to see the world – she was diagnosed with child-onset asthma at a young age.
The hassle of traveling with asthma
“When I was about 18 months old, I began wheezing after developing a cold. Shortly after, I was diagnosed with asthma,” Sullivan says. When she was younger, her asthma was much more severe than it is now as an adult. Periodically, her attacks would land her in the hospital and she had to have nebulizer treatments every four hours in addition to her daily medications.
This course of treatment proved challenging when she and her family traveled.
“The nebulizer treatments presented a difficult problem when traveling because we didn’t have a portable nebulizer. I remember having to stop in McDonald’s and other roadside restaurants on long road trips and to find an outlet to plug my machine into.”
Now, the publicity coordinator at a publishing company and budding author in Indianapolis, Indiana, says she is able to generally control her asthma with medication. But it’s still not all that simple when it comes to traveling.
“I have a portable nebulizer that I take with me on every trip in case of emergencies along with a supply of Albuterol to last at least five or so days, depending on how remote the destination is,” Sullivan says.
If you or a loved one has asthma, you know that albuterol is a medication that comes in an inhaler that relaxes muscles in the airways and increases airflow to the lungs – it’s used to prevent and treat wheezing, shortness of breath, coughing and chest tightness. When traveling, Sullivan also takes the oral steroid medication Prednisone with her as another emergency back-up.
Because of her asthma and the potential for environmental elements that can trigger an attack, Sullivan’s condition is at the forefront of her mind when she’s planning her trips.
“I know I may never make it back to Beijing because of the pollution levels there now. I also know to be cautious in Europe because, in my experience, many more people smoke openly there, which irritates my lungs. I was careful in Antarctica to keep my mouth and nose covered whenever the cold air started to hurt my lungs. And I knew that when I went to Cusco in Peru, I’d have to be ready for the altitude change.”
According to Dr. Julie Kuriakose, one of the founders and operating partners of Hudson Allergy in New York City, it’s important to know what your asthma triggers are, especially when traveling.
“The environment can play a tremendous role in triggering asthma attacks. As for why environmental elements can trigger asthma—it’s complicated. Some environmental exposures are simply irritating our airways, other environmental exposures are triggering immunologically mediated allergic reactions and other exposures may be epigenetically modifying our genes,” she explains, noting that asthma triggers can vary from person to person.
Heightened issues – trying to breathe at higher elevations
One such environmental trigger that can impact some people with asthmatics is higher altitudes.
“If your asthma is stable, altitude may have minimal clinical effects. But, at high altitudes, the air might be colder and more dry, both of which are potential asthma triggers,” Dr. Kuriakose says.
When it comes to higher altitudes, it’s not just the cold air that could impact someone’s asthma. The air is also thinner. Since there’s less air pressure, the result is less oxygen. Some people – even those without asthma or other breathing conditions – find that the thinner air can cause them to feel light-headed and fatigued. They may also have more difficulty breathing as a result of the lower oxygen level.
This is exactly the issue Sullivan ran into when she traveled to the Andes Mountains in Peru, which have an average elevation of about 13,000 feet above sea level.
“Every time I climbed a staircase, I felt winded. But in order to see some of the amazing sites that Peru offered, I often found
myself climbing uneven rock staircases with dozens of steps,” she says. “When I felt out of breath, I would sit down and rest. It helped that we had a private tour guide, so I was never holding up the rest of a tour group.”
The possibility that this could happen was something Sullivan was prepared for.
“Before I left home, I knew sometimes I would get winded. I prepared by exercising more so that I was in the best shape I could be.”
Although the cold and lower oxygen content may prompt some people’s asthma symptoms, higher altitudes can actually be beneficial to others, depending on their triggers.
“There may be less allergens in the air at higher altitudes, such as dust mites, which could be beneficial for dust mite allergic asthmatics,” Dr. Kuriakose says.
Don’t stop traveling… but plan ahead
Just because you have asthma doesn’t mean you shouldn’t travel – it just means you have a little more work and planning to do before you take flight.
“I would advise all asthmatic patients to make an appointment with the physician managing their asthma to discuss how to specifically prevent and manage their asthma symptoms prior to traveling. Each patient should have a written asthma action plan,” Dr. Kuriakose recommends.
However, in the case of someone with unstable or poorly controlled asthma, Dr. Kuriakose advises against traveling. Severe asthma is characterized by daytime symptoms throughout the day, nighttime symptoms as often as seven times per week, using a rescue inhaler several times a day, and extremely limited daily activities.
“Asthma severity can change, improve or worsen, therefore your asthma medications may need to be adjusted accordingly. So schedule regular follow up visits with your allergist,” says Dr. Kuriakose.
By meeting with your physician, working with her to get your asthma better managed and under control can put you on the path to traveling the world.
If someone with asthma is on the fence about traveling, Sullivan’s advice is “go for it!”
“Asthma doesn’t define who I am and I don’t let it dictate where I can go. With technology advancing, it’s so much easier to travel today than it ever was before with asthma,” she says.
Today’s nebulizer machines are smaller and more portable and it’s easier to keep in touch with your doctors during your travels in case of an emergency.
“Some destinations may not be appropriate for those with severe asthma, but for those with their asthma under control, it’s all in the preparation. As long as you have a plan, like having extra medications, knowing the location of the nearest hospital, and/or looking up local doctors before you leave, then asthma shouldn’t hold you back,” Sullivan says.
If you are asthmatic and planning to travel, here are some things you should be aware of and plan for.
First, you may need to spend a little extra time in airport security.
“More than once I’ve been pulled aside, especially when I traveled with my old, clunky nebulizer, to have the machine tested for bomb residue. Many TSA agents aren’t familiar with what it is,” Sullivan says.
If you are bringing a nebulizer and are traveling overseas, think about if you will need convertors or adapters to plug in and charge devices. You should also make sure to have copies of all of your prescriptions with you. In fact, bring multiple copies and store them in different bags, just in case something happens to your luggage.
If you are bringing the liquid form of one of your asthma or allergy medications, make sure you check what TSA policies are before heading to the airport. You’ll likely need to have some of the medication in your carry-on luggage just in case, so make sure you’re educated about the policies associated with liquid medications.
Speaking of medications, you should take more than you think you’ll need. It’s better to have too much rather than not enough; you could find yourself stranded somewhere or dealing with flight delays.
You should also take the time to research your destination.
“Look into doctors and hospitals close to where you’ll be staying ahead of time so you’re not panicking searching for one if something goes wrong,” Sullivan suggests.
That research can extend into looking for translations if you’re going somewhere where you don’t speak the language.
“Find the translation for asthma and how to ask for a doctor or hospital, so that you can take it with you for emergency purposes.”
And, of course, you should look into what potential asthma triggers you could run into in your destination.
“When planning a trip, I always do a lot of research into what vaccines I might need. In doing so, I usually come across any other medical issues that are commonly triggered in the area. I look for anything that might trigger my asthma so that I can be better prepared for it,” she says.
This prep work also includes meeting with her doctor before going to any destinations where medical assistance might not be readily available or where there is a language barrier. This pre-travel doctor’s visit also provides the opportunity to make sure you have enough emergency supplies of your medication.
“I think things like elevation, climate and pollution should always be considered when someone with asthma is planning a trip. But they should never hold someone back. There are often solutions, like smoke-free restaurants and hotels, wearing masks to help combat pollution and keeping yourself covered up in harsh climates,” Sullivan says.
So be smart about your asthma when traveling.
But don’t let it stop you.