Infectious Disease Book

Travel Medicine

  • Respiratory-Related Air Travel Restrictions


Respiratory-Related Air Travel Restrictions

Aka: Respiratory-Related Air Travel Restrictions, Respiratory Status Evaluation Before Air Travel, Preflight Respiratory Assessment, Hypoxia Altitude Simulation Test
  1. See Also
    1. See Air Travel Restrictions
    2. In-Flight Medical Emergency
  2. Indications: Preflight Assessment of Respiratory Conditions
    1. Bullous Lung Disease
    2. Automated Ventilator Support (e.g. CPAP)
    3. Cystic Fibrosis
    4. Acute respiratory illness requiring hospitalization within last 6 weeks
    5. Preexisting Supplemental Oxygen or Ventilatory requirements
    6. History of respiratory distress on prior air travel
    7. Pulmonary Tuberculosis
    8. Recent Pneumothorax (esp. residual Pneumothorax)
    9. Severe COPD (Predicted FEV1 <30%)
    10. Severe Persistent Asthma
    11. Severe Restrictive Lung Disease (Vital Capacity <1 L)
  3. Evaluation: Hypoxia Altitude Simulation Test
    1. Technique
      1. Patient breaths air wih 15% FIO2 via mask (room air at sea level is FIO2 of 23%) for 20 minutes
      2. Pulse Oximetry and Blood Gas are performed before and after breathing 15% oxygen
    2. Interpretation
      1. PaO2 <50 mmHg at any point indicated Supplemental Oxygen requirements
      2. PaO2 >55 mmHg does NOT require Supplemental Oxygen
    3. References
      1. Dine (2008) Chest 133(4): 1002-5 [PubMed]
  4. Management: Air Travel Restrictions
    1. Hypoxia
      1. Avoid air travel
        1. Patients unable to walk 50 meters due to Dyspnea or Hypoxia
        2. Oxygen requirements >4 L/min
      2. Chronic, stable Supplemental Oxygen requirements <4 L/min
        1. Double usual oxygen flow rate during flight
        2. Portable oxygen compressors are allowed on flight per FAA, but require >48 hour notice to airline
    2. Chronic Obstructive Pulmonary Disease (COPD)
      1. No air travel if Vital Capacity <50% of predicted
    3. Asthma
      1. No restriction if stable
    4. Pneumothorax
      1. No flight for 10 days after resolution
    5. Open-ChestLung Procedure
      1. Avoid air travel for 2-3 weeks
      2. Assess for Supplemental Oxygen before travel
      3. No recent or residual Pneumothorax at time of air travel
  5. References
    1. Powell-Dunford (2021) Am Fam Physician 104(4): 403-10 [PubMed]

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