1. Fitness to Fly

2. The Problem Every year 2 billion people fly Every year 2 billion people fly Cheap travel started 30 years ago Cheap travel started 30 years ago 40-50 yr olds now 70-80 yrs 40-50 yr olds now 70-80 yrs Older people have more disposable income Older people have more disposable income Families spread round globe Families spread round globe Sick and disabled want to fly too Sick and disabled want to fly too

3. Cabin environment Cabin pressure decreases from 100kPa to 75kPa Cabin pressure decreases from 100kPa to 75kPa Gas expands as pressure fall Gas expands as pressure fall Oxygen pressure falls Oxygen pressure falls Air drawn from outside aircraft Air drawn from outside aircraft Air is cold Air is cold Very little moisture – dry eyes etc Very little moisture – dry eyes etc

4. Seating Seats tightly packed Seats tightly packed Immobility Immobility Cramped seating Cramped seating Spread of ariborne diseases Spread of ariborne diseases

5. Medical facilities Flights over large oceans nowhere to divert to Flights over large oceans nowhere to divert to Medical kit limited Medical kit limited No Doctor No Doctor Difficult environment to cope with medical emergency Difficult environment to cope with medical emergency

6. Assessment Severe Asthma Severe Asthma Severe COPD Severe COPD Severe restrictive lung diseases Severe restrictive lung diseases Cystic fibrosis Cystic fibrosis Co-morbidity with illnesses causing hypoxaemia Co-morbidity with illnesses causing hypoxaemia Within 6/52 discharge for rti Within 6/52 discharge for rti Already requiring oxygen Already requiring oxygen

7. Who requires Oxygen Haemoglobin oxygen sats 92% or less Haemoglobin oxygen sats 92% or less Hb sats 95% don’t Hb sats 95% don’t Hb sats 92%-95% need assessment Hb sats 92%-95% need assessment

8. Gas volume changes Middle ear Middle ear –Ascending pos pressure in ear forces open eustachian tube no problem –Descending negative pressure in middle ear has opposite effect if eustachian tube dysfunctional get otic barotrauma

9. Gas volume changes Sinuses Sinuses –Inability to equalise pressure in sinuses particularly frontal sinus can cause excruciating pain –Usually due to urti –Avoid flying –Ephedrine nasal drops –Oral pseudoephedrine

10. Gas volume changes Lung bullae Lung bullae –Risk of rupture not known Closed pneumothorax don’t fly Closed pneumothorax don’t fly Don’t fly following surgical proceedures that have left gas in delicate structure Don’t fly following surgical proceedures that have left gas in delicate structure Don’t dive in 24 hours before flying Don’t dive in 24 hours before flying

11. Deep vein thrombosis Risk not known Risk not known Immobility in cramped position Immobility in cramped position Pressure on popliteal vein Pressure on popliteal vein Mild hypoxia Mild hypoxia Mild dehydration Mild dehydration

12. Prevention Regular exercises Regular exercises Walking around cabin Walking around cabin Avoid alcohol drink fluids ++ Avoid alcohol drink fluids ++ Avoid long periods of sleep Avoid long periods of sleep Below knee compression stockings Below knee compression stockings ? aspirin ? aspirin

13. High risk flyers Flights less than 4 hours Flights less than 4 hours –Usual advice –Stockings aspirin Flights more than 4 hours Flights more than 4 hours –Clexane 40mgs on day of outward and inward flight –Pre-filled syringe –Given at airport