Traveling by airplane is generally safe and comfortable for the vast majority of people, even those with a pre-existing lung disease like chronic obstructive pulmonary disease (COPD). Some COPD patients, however, may be at risk for developing hypoxemia (low blood oxygen) during air travel and may need in-flight oxygen, even if they donât normally require it. How do you know if youâll need oxygen therapy when you fly? Predicting this is often difficult.
Cabin Pressure in a Commercial Aircraft
At cruising altitudes (40,000 feet) the air cabin of a commercial aircraft is pressurized to an equivalent of approximately 8,000 feet above sea level. This means that during flight, the air cabin contains less oxygen. Although this is not likely to bother passengers with healthy lungs, people with compromised lung function may not be able to tolerate it and develop significant hypoxemia and respiratory distress. In-flight oxygen would allow people who fall into this category to travel safely.
Anyone with COPD planning to travel by airplane should make an appointment with their physician to have a pre-flight assessment. A pre-flight assessment enables your physician to identify whether or not youâre likely to develop respiratory symptoms during air travel and if youâll need supplemental oxygen.
Who Needs In-Flight Oxygen?
There are several methods of determining the need for in-flight oxygen, the âgold standardâ being the high altitude simulation test (HAST). Because this test is highly sophisticated and not widely available, physicians often rely on a patientâs resting oxygen saturation (SpO2) and the presence of risk factors to help them determine a patientâs oxygen needs during air travel. Mathematical prediction equations are also available; however these are less accurate and often overestimate the need for in-flight oxygen.
Using a Clinical Algorithm to Determine Fitness to Fly
One solution is to use a clinical algorithm1 thatâs based on resting and exertional SpO2 as measured by pulse oximetry. The algorithm was created based on a study consisting of 100 patients, each with moderate to very severe COPD. Results of the study, which was published in THORAX, placed the patients in one of three groups:
Hereâs what the algorithm looks like:
If SpO2 < 92%, the patient should be prescribed in-flight oxygen.
If SpO2 is 92-95%, the patient should undergo a 6MWT:
If SpO2 >95%, then the patient should undergo the 6MWT:
If 6MWT SpO2 > or = 84%, then in-flight O2 is not recommended.
Tips for Flying
Although some people with lung disease may be at risk for developing hypoxemia during flight, careful pre-flight screening can identify this group and most will be able to fly safely using supplemental oxygen.
Additionally, for those who donât already use supplemental oxygen, the following tips should be considered:2
Author: Deborah Leader RN, BSN, PHN
1 Anne Edvardsen et al. Air travel and chronic obstructive pulmonary disease: a new algorithm for pre-flight evaluation. Thorax 2012;67:964-969.
2 A. Johnson. Chronic obstructive pulmonary disease: Fitness to fly with COPD. Thorax 2003;58:729-732 doi:10.1136/thorax.58.8.729.
Photo Credit: Flickr, airplane, Yuichi Kosio