1. Managing passengers with respiratory disease planning air travel By :saeed Lotfi M.D

2. Introduction The flight environment and effect of altitude Pre- flight assessment for adults The following group should be assessed: ☻ Severe COPD or asthma ☻ Severe restrictive disease ☻ Cystic fibrosis ☻ History of air travel intolerance with respiratory symptoms ☻ T.B ☻ Within 6 weeks of hospital discharge for acute respiratory illness ☻ Recent pneumothorax ☻ Risk of a previous venous thromboembolism ☻ Pre-existing requirement for oxygen or ventilator support

3. The following assessment is recommended history and examination PFT Measurement of SPO2 by pulse oximetry The following groups should not fly: patients with infectious tuberculosis must not travel by public air transportation until rendered non-infectious those with a current closed pneumothorax should avoid commercial air travel Patients who have undergone major thoracic surgery should ideally delay flying for 6 weeks after an uncomplicated procedure. Lung cancer per se is not a contraindication to flying. However, associated respiratory diseases should be considered in their own right.

4. Disease specific recommendations Asthma Preventative and relieving inhalers should be carried in the hand luggage Portable nebulisers may be used at the discretion of cabin crew COPD Passengers should travel on a non-smoking flight Preventative and relieving inhalers should be carried in the hand luggage Patients prescribed in-flight oxygen should receive oxygen while visiting high altitude destinations Portable nebulisers may be used at the discretion of cabin crew

5. Previous pneumothorax Patients with a current closed pneumothorax should not travel on commercial flights Patients may be able to fly 6 weeks after a definitive surgical intervention and resolution of the pneumothorax Patients who have not had surgery must have had a chest radiograph confirming resolution, and at least 6 weeks must have elapsed following resolution before travel. Thoracic surgery Air travel should be delayed for at least 2 weeks after uncomplicated chest surgery, and confirmation of resolution of any pneumothorax or collected air by chest radiography is recommended

6. Additional precautions for all passengers excess alcohol should be avoided before and during the flight, particularly in those with obstructive sleep apnea and those at risk of venous thromboembolism patients should carry preventative and relieving inhalers in their hand luggage supplementary in-flight oxygen is usually prescribed at a rate of 2 l/min and should be given by nasal cannulae. dry cell battery powered continuous positive airway pressure (CPAP) machines may be required by patients with obstructive sleep apnoea on long haul flights, but they must be switched off before landing

7. Physiological effects of exposure to altitude Clinical pre-flight assessment The 50 metre walk Predicting hypoxaemia from equations Hypoxic challenge test Sao2Pao2 9795-105 9470-75 9267-73 9058-62 8752-58 8446-52

8. Available equations for predicting Pao2 at 8000 feet altitude  Pao2 (alt) =0.84 + ( 0.68 ) Pao2 (ground )  Pao2 (alt) =0.453 Pa02 (ground ) + 0.386 (Fev1% predicted) +2.44  Pao2 (alt) =0.245 Pao2 (SL) + 0.171 (Fev1/Fvc%predicted) +21.028

9. Should This Patient Use Supplemental Oxygen During Commercial Air Flight? A 65-year-old former smoker with stable chronic obstructive pulmonary disease (COPD) He has no history of anemia, coronary artery disease, or stroke. PaO2 8,000 ft = 0.453 (62) + 0.386 (42) + 2.44 PaO2 8,000 ft = 46.738 TestPredictedMeasured%predicted FEV1 3.411.4342 FVC 4.413.784 FEV1/ FVC 0.810.3948 Pao2 62 Paco2 40 PH 7.41