Do You Need In-Flight Oxygen?

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 don’t normally require it. How do you know if you’ll 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.

Pre-Flight Assessment

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 you’re likely to develop respiratory symptoms during air travel and if you’ll need supplemental oxygen.

Who Needs In-Flight Oxygen?

There are several methods of determining the need for in-flight oxygen, the “gold standard” being the high altitude simulation test (HAST). Because this test is highly sophisticated and not widely available, physicians often rely on a patient’s resting oxygen saturation (SpO2) and the presence of risk factors to help them determine a patient’s 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.

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Using a Clinical Algorithm to Determine Fitness to Fly

One solution is to use a clinical algorithm¹ that’s 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:

1. Those who were fit to fly without further evaluation.
2. Those who needed further evaluation with HAST to determine their fitness to fly.
3. Those who needed in-flight oxygen without the need for further testing.

Here’s 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 6MWT SpO2 < 84%, the patient should be prescribed in-flight oxygen.
• If 6MWT SpO2 > or = 84%, then the patient should undergo HAST to further evaluate the need for in-flight oxygen.

If SpO2 >95%, then the patient should undergo the 6MWT:

• If 6MWT SpO2 < 84%, then the patient should undergo HAST.

If 6MWT SpO2 > or = 84%, then in-flight O2 is not recommended.

Tips for Flying with Oxygen

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 don’t already use supplemental oxygen, the following tips should be considered:²

• Before making final travel arrangements, always consider the altitude of layover airports as well as the final destination.
• Plan accordingly; not all airlines provide in-flight oxygen and others have restrictions.
• Consider the cost of in-flight oxygen vs. the price of the airline ticket before making your final arrangements.
• Give the airline plenty of notice of your need for in-flight oxygen and check the day before travel that all arrangements have been made.
• All prescription medication, including your oxygen prescription, should be carried on-board the airline with you.
• Avoid smoking and alcohol consumption before and during air travel.

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