Is it safe for patients with pulmonary fibrosis to fly and what precautions should they take?

Air Travel Safety for Patients with Pulmonary Fibrosis

Patients with pulmonary fibrosis should undergo pre-flight assessment to determine if supplemental oxygen is needed during air travel, as the reduced cabin pressure can cause significant hypoxemia and respiratory distress. 1

Pre-Flight Assessment Algorithm

Initial Screening

• Patients with pulmonary fibrosis should be assessed before flying, as they fall under the category of "severe restrictive disease" 1
• Assessment should include:
  • Medical history and examination focusing on cardiorespiratory symptoms and previous flying experience 1
  • Spirometry testing 1
  • Measurement of oxygen saturation (SpO₂) by pulse oximetry at rest 1

Decision-Making Based on SpO₂ Levels

• If sea level SpO₂ >95%: Oxygen not required during flight 1
• If sea level SpO₂ 92-95% with no additional risk factors: Oxygen not required 1
• If sea level SpO₂ 92-95% with additional risk factors (including restrictive lung disease involving parenchyma/fibrosis): Perform hypoxic challenge test 1
• If sea level SpO₂ <92%: In-flight oxygen is recommended without further testing 1
• If already receiving supplemental oxygen at sea level: Increase the flow rate while at cruising altitude 1

Hypoxic Challenge Testing

• For patients with borderline oxygen levels (SpO₂ 92-95%) with risk factors, a hypoxic challenge test should be performed 1
• This test simulates the cabin environment by having the patient breathe 15.1% oxygen 2
• If PaO₂ during the test is <6.6 kPa (49.5 mmHg), supplemental oxygen is recommended during flight 1, 3

Practical Recommendations for Air Travel

For All Pulmonary Fibrosis Patients

• Avoid excess alcohol before and during the flight 1
• Remain mobile during the flight if not receiving oxygen 1
• Be aware that exercise without supplemental oxygen may worsen hypoxemia; inform flight attendants when leaving seat if severely compromised 1
• Take preventive measures against venous thromboembolism, especially for long flights 1
• Carry all medications in hand luggage 1
• Check with pharmacist whether any medications may be adversely affected by extreme temperatures in hold baggage 1

For Patients Requiring In-Flight Oxygen

• Disclose oxygen needs when booking with the airline 1
• The airline medical department will issue a medical form (MEDIF) requiring completion by both patient and healthcare provider 1
• Consider oxygen needs on the ground and during flight connections 1
• In-flight oxygen is typically prescribed at 2 L/min via nasal cannulae 1
• Oxygen can be switched on when the plane reaches cruising altitude and switched off at the start of descent 1
• Patients cannot use their own oxygen cylinders or concentrators during flight but may be able to take empty ones as baggage (check with airline) 1
• Compare charges across airlines, as fees for in-flight oxygen vary considerably 1

For Oxygen-Dependent Patients

• Special arrangements must be made with airline and airport authorities 1
• Consider transport to aircraft by ambulance if needed 1
• Carry all usual medications, a copy of medical forms, and travel with a companion 1
• Choose direct flights when possible; if connections are unavoidable, make separate arrangements for oxygen during stopovers 1
• Ensure oxygen availability throughout the entire stay at destination 1, 4
• Make arrangements for both outward and return journeys 1

Important Caveats and Considerations

• Even with in-flight oxygen, air travel cannot be guaranteed to be completely safe for all patients 1
• Patients with pulmonary fibrosis visiting high-altitude destinations should continue to use oxygen at these locations 1, 5
• For patients with severe disease, medical escort may be necessary, especially for long flights 1, 5
• Despite challenges, most patients with severe lung disease can travel safely with proper preparation, sufficient oxygen supply, monitoring, and medical support if needed 5
• Patients often find practical and psychological limitations of oxygen use more pronounced than anticipated, but generally report benefits in symptoms, confidence, and mobility 4