Download Managing passengers with respiratory disease planning air travel

Managing passengers with respiratory
disease planning air travel
By :saeed Lotfi M.D
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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
The following assessment is recommended
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history and examination
PFT
Measurement of SPO2 by pulse oximetry
The following groups should not fly:
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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.
Disease specific recommendations
Asthma
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Preventative and relieving inhalers should be carried in the
hand luggage
Portable nebulisers may be used at the discretion of cabin
crew
COPD
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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
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Previous pneumothorax
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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
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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
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Additional precautions for all passengers
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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
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Physiological effects
of exposure to altitude
Clinical pre-flight
assessment
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The 50 metre walk
Predicting hypoxaemia
from equations
Hypoxic challenge test
Sao2
Pao2
97
95-105
94
70-75
92
67-73
90
58-62
87
52-58
84
46-52
 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
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
Test
Predicted
Measured
%predicted
FEV1
3.41
1.43
42
FVC
4.41
3.7
84
FEV1/
FVC
0.81
0.39
48
Pao2
62
Paco2
40
PH
7.41