Should I stay or should I go? COPD and air travel

Abstract

Chronic obstructive pulmonary disease (COPD) is a challenging respiratory problem throughout the world. Although survival is prolonged with new therapies and better management, the magnitude of the burden resulting from moderate-to-severe disease is increasing. One of the major aims of the disease management is to try to break the vicious cycle of patients being homebound and to promote an active lifestyle. A fundamental component of active daily life is, of course, travelling. Today, the world is getting smaller with the option of travelling by air. Air travel is usually the most preferred choice as it is easy, time saving, and relatively inexpensive. Although it is a safe choice for many passengers, the environment inside the aeroplane may sometimes have adverse effects on health. Hypobaric hypoxaemia due to cabin altitude may cause health risks in COPD patients who have limited cardiopulmonary reserve. Addressing the potential risks of air travel, promoting proactive strategies including pre-flight assessment, and education of COPD patients about the "fitness to fly" concept are essential. Thus, in this narrative review, we evaluated the current evidence for potential risks of air travel in COPD and tried to give a perspective for how to plan safe air travel for COPD patients.

FIGURE 1

World Bank Data for numbers of passengers who travelled by air between 1970 and 2016. Reproduced from [4] with permission.

FIGURE 2

Oxyhaemoglobin dissociation curve for healthy individuals and patients with chronic obstructive pulmonary disease (COPD) at high altitude. P_O2: oxygen tension. Reproduced from [26] with permission.

FIGURE 3

Pathophysiological changes in chronic obstructive pulmonary disease during air travel. P_IO2: inspired oxygen tension; P_AO2: alveolar oxygen tension; P_aO2: arterial oxygen tension; P_aCO2: arterial carbon dioxide tension; PEEP: positive end-expiratory pressure; RV: right ventricle.

FIGURE 4

Algorithm for the assessment of fitness to fly in chronic obstructive pulmonary disease patients. LTOT: long-term oxygen therapy; P_aO2: arterial oxygen tension; S_pO2: arterial oxygen saturation measured by pulse oximetry; 6MWT: 6-min walk test. ^#: if dyspnoea on exertion, forced expiratory volume in 1 s <1.5 L or <30% predicted, a pre-existing requirement of oxygen/ventilatory support, bullous lung disease, comorbid conditions that may worsen hypoxaemia like cardiac disease and significant symptoms during previous air travel.