Managing passengers with respiratory disease planning air travel: British Thoracic Society recommendations.

INTRODUCTION Need for recommendations on managing passengers with lung disease planning air travel Air travel is now a common mode of travel for millions, with a single UK airline carrying over 33 million passengers annually. It is estimated that over one billion passengers travel by air worldwide each year, and for the majority this is without hazard. Despite current uncertainties about the future of the airline industry, it seems likely that air travel will continue to offer a convenient form of transport for many. In the longer term passenger numbers may therefore increase further. Given the rising age of western populations, the age of air travellers is also likely to increase, with greater propensity for medical impairment. Over 25 years ago it was already estimated that 5% of commercial airline passengers were ambulatory patients with some illness including chronic obstructive pulmonary disease (COPD). There are still no established methods for quantifying the risk of in-flight medical problems. However, a North American service offering expert assistance by radio link for in-flight medical emergencies logged 8500 calls in 2000, of which 11% were respiratory in nature. Physicians should therefore be aware of the potential effects of the flight environment in passengers with lung disease. One million residents of Denver, Colorado live at 5280 ft (1609 m) and coaches crossing high Alpine passes reach 10 000 ft (3048 m), indicating that moderate hypoxaemia is not generally hazardous. Nevertheless, greater awareness of the risks of air travel will enable physicians to encourage patients to fly safely wherever possible and increase the safety of fellow air passengers. The aircraft crew are subject to regular medical examination but passengers are not. For potential passengers with lung disease it would clearly be valuable for their physician to have recommendations for assessing the fitness of their patients for flying. A recent national survey of respiratory physicians indicated that many would welcome advice. Sources of available information include British and European, North American, and Canadian COPD guidelines, aviation medicine textbooks, supplements to the journal Aviation, Space & Environmental Medicine and other publications on air travel. However, these references may not always be readily accessible to physicians and do not all provide consistent, practical, or comprehensive coverage. In particular, there is disparity between European and North American guidelines, uncertainty about assessment methods, and failure to consider other respiratory causes of hypoxaemia such as pulmonary fibrosis. To meet the need for consistent, practical, and comprehensive advice, the British Thoracic Society (BTS) Standards of Care Committee set up a Working Party to formulate national recommendations for managing patients with lung disease planning air travel. There is currently insufficient evidence to produce formal guidelines. The following recommendations are derived from literature reviews and aim to provide practical advice for respiratory physicians. They apply to commercial flights only and exclude emergency aeromedical evacuation situations.