Does a portable oxygen concentrator (POC) work effectively on an airplane?

Portable Oxygen Concentrators on Airplanes

Portable oxygen concentrators (POCs) can work on airplanes, but patients cannot use their own personal concentrators during flight—airlines prohibit passengers from using their own oxygen cylinders or concentrators, though empty devices may be transported as baggage. 1

Key Regulatory and Practical Limitations

Airlines require passengers to use airline-supplied oxygen systems or airline-approved POCs only. The British Thoracic Society guidelines explicitly state that patients cannot use their own cylinder or concentrator during flight, though they may be able to take these items as baggage if empty after checking with the airline first. 1

In-Flight Oxygen Flow Restrictions

• In-flight oxygen flow is typically limited to 2 L/min or 4 L/min by most airlines, regardless of the delivery system used. 1
• This standardized flow rate (usually 2 L/min via nasal cannulae) should be initiated at cruising altitude and may be discontinued at the start of descent. 1
• For patients already on oxygen at sea level, the flow rate should only be increased while at cruising altitude. 1

Performance of POCs at Altitude

Evidence from Simulated Flight Conditions

Research demonstrates that POCs can function at typical cabin altitudes (equivalent to 2438-2650 m), but with important performance limitations:

• All tested POCs were able to increase PaO₂ by at least 1.40 kPa (10 mmHg) at simulated cabin altitude in patients with COPD. 2
• However, lightweight POCs (Freestyle and Invacare XPO2) had to operate at maximum settings to achieve adequate oxygenation, significantly reducing battery life. 2
• Heavier POCs (EverGo, Inogen One, Eclipse 3) provided greater safety margins, increasing PaO₂ by more than 2.55 kPa (20 mmHg), which is crucial for patients with severe baseline hypoxemia. 2

Critical Technical Considerations

POCs tested under true hypobaric hypoxia (pressure chamber simulating flight) produced lower oxygen concentrations than at sea level (FiO₂ 0.92 vs. 0.93), though most maintained FiO₂ ≥ 0.90. 3 Importantly, normobaric hypoxia testing (using oxygen tents) does not accurately predict POC performance in actual flight conditions—devices tested this way achieved only FiO₂ of 0.76, far below their actual capability at altitude. 3

Pre-Flight Requirements and Logistics

Mandatory Airline Coordination

Patients must disclose oxygen needs when booking and complete airline medical forms (MEDIF or equivalent) that require information from both patient and physician about diagnosis, oxygen requirements, recent blood gases, and equipment needs. 1

Ground Oxygen Arrangements

Airlines do not provide oxygen for airport use—patients must arrange separate oxygen supply for:

• Airport terminals before boarding 1
• Ground time during connecting flights 1
• Some airports restrict oxygen use due to explosion risk 1

For Oxygen-Dependent Patients

Totally oxygen-dependent patients require special arrangements:

• Transport to aircraft by ambulance may be necessary 1
• Direct flights are strongly preferable 1
• Separate oxygen arrangements must be made for stopovers 1
• Patients should ensure long-term oxygen therapy (LTOT) availability at their destination 1
• Return journey oxygen must be arranged in advance 1

Clinical Assessment Algorithm

Who Needs In-Flight Oxygen

Based on sea-level oxygen saturation:

• SpO₂ >95%: No oxygen required 1
• SpO₂ 92-95% without risk factors: No oxygen required 1
• SpO₂ 92-95% with risk factors: Perform hypoxic challenge test 1
• SpO₂ <92%: In-flight oxygen required 1

Risk factors include: hypercapnia, FEV₁ <50% predicted, lung cancer, restrictive lung disease, ventilator support, cerebrovascular/cardiac disease, or exacerbation within 6 weeks. 1

Important Caveats

Weight alone should not determine POC selection—battery life and maximum oxygen output are equally critical considerations for safe air travel. 2 The combination of limited airline-supplied flow rates (2-4 L/min maximum) and variable POC performance at altitude means that patients requiring higher flow rates at sea level may face significant challenges during flight. 1

Over-the-counter POCs purchased online without FDA clearance may be inadequate for hypoxemic patients, as recent testing showed most OTC devices failed to provide meaningful oxygen supplementation. 4