Flying with COPD: A nightmare or a pleasant journey?

Chronic Obstructive Pulmonary Disease (COPD) is a significant health concern that used to be considered untreatable, but enhancing patients' well-being and improving their quality of life is now made possible thanks to recent advancements. Be it the personalized medical treatments patients receive based on their individual needs or the effective exacerbation management and support for physical activity and rehabilitation, there are now many ways to help COPD patients. Other than these, accessible treatments like long-term oxygen therapy and noninvasive ventilation are empowering COPD patients to have a more active lifestyle, which brings us to today’s topic: Air travel with COPD.
No need to mention that commercial air travel is a preferred and common mode of transportation for billions of passengers all around the world each year. Taking the aging population into account, this means more and more travelers with pre-existing conditions like COPD. In this context, it should be one of the missions of healthcare providers and patients to assess and minimize the potential risks that are associated with air travel in order to ensure the safety and health of COPD patients. Of course, there are ways to enable a comfortable flight where you can sit back and relax, which we will be going over in this very article as well.
So what are the potential situations that may occur? First off, since aircraft cabins are pressurized to 8000 feet above sea level, the oxygen levels in the aircraft are reduced. For individuals that do not have COPD, the risk of experiencing hypoxia is low, but the same cannot be said for COPD patients. The primary difference between cabin and ground environments is atmospheric pressure, resulting in hypobaric hypoxia for not just individuals with COPD, but all passengers. COPD patients are at higher risk due to the fact that hyperventilation and hyperinflation are known to worsen hypoxia, especially during minor activity.
Subtle hypoxia symptoms, such as cognitive impairment are a potential risk that can be experienced by a COPD patient during air travel. Unfortunately, medical emergencies during flights are relatively common, occurring in approximately one out of every 604 flights, with respiratory illnesses accounting for a significant proportion of these cases. One should also mention that diversion due to medical issues can be costly as well. Therefore, it is suggested to do a pre-flight screening for at-risk passengers for the sake of reducing such inconvenient events.
Acute hypoxia triggers sympathetic activation, resulting in increased heart rate, blood pressure, and cardiac output. This results in severe complications during the flight, including cardiac arrhythmias and chest pain for patients who cannot respond adequately to these physiological changes. Other than hypoxia, COPD patients may experience common symptoms of COPD during air travel, like shortness of breath and chest pain, often exacerbated by cabin conditions of low humidity and recirculated air. Additionally, sleep is common during long-haul flights, and it can cause significant drops in oxygen saturation, particularly in COPD patients.
Although assessing COPD patients for in-flight hypoxemia is a complex process, and there is no consensus on the gold standard assessment method, pulmonary function tests, such as spirometry, can provide valuable information. But again, even their ability to predict in-flight hypoxemia is limited. Walk tests, for instance the 6-minute walk test, can assess functional capacity and exercise-induced hypoxemia.
“So, are you indicating that COPD patients should not fly?” Of course, that is not the case. There are ways to prepare COPD patients for air travel and optimize their treatment. Assessing their risk of in-flight hypoxemia is one point to start. Involving general practitioners in the process, ensuring an adequate supply of medications, and having proper health insurance are key to planning your flight. Other than that, supplemental oxygen is crucial for many patients to prevent acute hypoxia and the choice of delivery method depends on their clinical status. COPD patients and their caregivers must also consider additional factors like jet lag, sleep disturbances, and the risk of thromboembolism, and be cautious about respiratory infections.
In conclusion, traveling with COPD may be a risk to take, but not something to be afraid of when carefully planning and considering the unique challenges of that certain flight are thoroughly done. Many patients can safely fly, assuming that their specific needs are addressed. Disease management done with proactive strategies during air travel is essential for ensuring COPD patients’ well-being: Both on the ground and in the air. In this process, healthcare providers, patients, and airlines all play non-interchangeable vital roles, each in their own way.
To help you in your pre- journey planning, we recommend you use our Breathment App where you can perform exercises from home that are assigned to you based on your individual needs and proven to improve your quality of life. Book an appointment now to explore how Breathment helps you ease your symptoms easily.