Nevertheless, the severity of lung dysfunction was reflected by the large numbers of COPD and other respiratory patients who were receiving oral corticosteroids or home oxygen therapy or who electively requested in-flight supplemental oxygen. A comparison of in-flight morbidity between screened passengers and patients who had not undergone preflight screening would have been informative. However, this protocol design would be logistically and ethically difficult with our current understanding and concerns about patients who travel by air. This study did not evaluate gate or in-flight emergencies which are situations for future investigation.
This survey presents novel information and a perspective of contemporary medical conditions of patients who travel by air, their flight itineraries, and the frequency of requests for supplemental oxygen in the United States. The only other similar study was reported by Dillard and colleagues who surveyed 100 military-related patients with severe COPD. Forty-four patients traveled by commercial air carrier over a 28-month period with the median duration of 3 h for the longest flight segment. Unlike our results, 2 (4.5 percent) of the air travelers and 17 (30.3 percent) of the nontravelers used home oxygen. Twelve (27.2 percent) patients who traveled by air consulted with a physician before flight time. Twenty-five (56.8 percent) patients ambulated aboard the aircraft, and eight patients reported transient dyspnea or other cardiopulmonary symptoms during the flight. Two patients requested oxygen for treatment of in-flight symptoms, although hospitalization was not necessary for any patient. The number of patients who were advised to use or who used prearranged supplemental oxygen during flight was not reported.
Patients with pulmonary disorders and, in particular, combined cardiopulmonary conditions (eg, both COPD and cardiac disorder) may be at greater risk for adverse health effects from the acute hypoxia of high altitude travel. However, the great majority of the screened patients did not have preflight arterial blood gas value determinations performed or reported, despite their underlying cardiopulmonary disorders and the predictive usefulness of Pa02. The degree of altitude hypoxemia or tolerance can be estimated by screening regression equations or with the hypoxia-altitude simulation test. Preflight assessment of altitude tolerance can assist the physician and airline in decisions regarding the need for elective oxygen or other special arrangements or services. Such arrangements may not only provide adequate oxygenation, but also obviate the emergency need for oxygen, possible flight diversion, and resulting disruption of the flight schedules of the patient, other passengers, and the carrier.
Although the study found a large proportion (80 percent) of oxygen-requesting patients, the remaining patients (20 percent) also had medical conditions which could have been affected by the stresses of high altitude travel. These patients were judged to be capable of safe air travel without supplemental oxygen, although their flight itineraries were just as long as those in the oxygen group. Patients in the other pulmonary group frequently had asthma or cardiac disorders which required medications. Patients in the nonpulmonary group had neuropsychiatric, orthopedic, cardiac, and malignant disorders as the major diagnoses requiring antiseizure medications, antibiotics, analgesics, or cardiac medications. The common use of medications underscores the need to advise patients to carry their prescribed medications aboard the flight.
In conclusion, preflight screening and planning may have effectively reduced in-flight morbidity, which was not reported from the flights of these patients. Findings from this study support the impression that large numbers of patients with stable or semistable medical conditions are using commercial air carriers, with and without in-flight oxygen therapy. The large numbers of cardiorespiratory patients who travel by air support the importance of preflight screening, counseling, and, if appropriate, in-flight oxygen therapy. A sizeable number of patients were recently hospitalized and intended to travel shortly after discharge. This not infrequent situation places the patient and carrier at increased risk for in-flight problems unless the patient is adequately screened and prepared. The results of this study indicate that preflight medical screening and counseling can be performed effectively and provide further assurance of a safe and comfortable flight.