FAQ’s: Travel, Altitude, Cold & Allergy Medications with PAH

Your Questions Answered

Altitude and PAHIs it safe to travel to high altitude with Pulmonary Hypertension?

This is an important question for patients with any chronic heart or lung problem, and especially important for patients with PAH.  As we ascend to higher elevations a variety of changes take place in our heart and lungs.  Heart rate increases immediately.  Pulmonary artery pressures increase at rest and even more so with exercise.  Oxygen levels decline the higher the elevation.  Most patients don’t experience any problems with elevations of less than 3,000 feet (approximately 1,000 meters).  Patients with mild PAH (mean pulmonary artery pressure less than 35 and normal cardiac output) generally do well with elevations less than 6,000 feet though some patients are particularly sensitive.  Patients with more severe PAH are less tolerant of elevation.

What can I do to travel more safely to higher elevations?

First, you should always check with your PAH physician.  There is a test called a High Altitude Simulation Test that allows your doctor to see if you drop your oxygen saturation at oxygen conditions that mimic commercial airline travel (8,000 feet elevation equivalence). This test accurately identifies patients that require supplemental oxygen but does not tell us how your right ventricle handles the added stress of high elevation.

Second, if you have severe PAH, avoid exposure to elevations greater than 3,000 feet when possible.

Third, travel with oxygen if you meet the appropriate criteria.

Fourth, return to lower elevation if you are feeling poorly.

If I have a cold, what medications can I take for nasal congestion and cough?

Unfortunately having PAH does not protect you from all the common illnesses such as seasonal colds and respiratory infections.  There is no magic medicine to treat the cough, nasal congestion and achiness.  There are some medicines that should definitely be avoided and these include Decongestants such as Afrin, Oxymetazoline, Phenylephrine, Sudafed, and Pseudoephedrine.  These medicines are vasoconstrictors—this means that they act by squeezing the blood vessels.  Unfortunately in addition to squeezing the blood vessels in your nose to decrease your runny nose, they also squeeze your pulmonary arteries and can lead to worsening pulmonary hypertension.

Another strategy to dry your nose and congestion is first generation antihistamines such as Benadryl or Chlorpheniramine.  These are safe for PAH patients though if you are an older man and have trouble urinating you should be careful.  Cough and mucous symptoms can be very frustrating.  Over the counter Guaifenesin offers mild benefit and is very safe.  Many patients find that it loosens secretions.  Cough suppressants include Dextromethorpan, Ricola and other cough drops that are over the counter may provide relief and are quite safe.  There are a variety of prescription cough suppressants that may be tried if your symptoms persist.  Time and patience are the best medicine.

What can I take for seasonal allergies?

All of the antihistamines are safe for PAH patients.  The first generation antihistamines like Benadryl and Chlorpheniramine are inexpensive and effective but are sedating. The newer agents (second generation antihistamines) are also very effective and don’t cause sedation. These agents include Zyrtec (cetirizine), Allegera (fexofenadine), Claritin (loratadine) and others.  Avoid the “D” which is the added decongestant that can cause increased pulmonary artery pressure. 

Nasal steroid sprays are very effective for treating allergic nasal symptoms and are now available over the counter.  In general they are very well tolerated and extremely safe.  They don’t work instantly, so many patients find that they benefit most when they use this type of medicine for a period of time when they are experiencing more allergy symptoms.