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Annual Congress of Malaysian Thoracic Society
Symposium 4B
Air-Travel Related Disorders
Managing patients who require oxygen during air travel
Norhaya Mohd Razali
Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia
Travelling by air whether for going on a holiday or for some other purposes, precautions should be taken while
flying. Air travel has no wrong or significant effect on health. However, it is a well known fact that travelling
long distances in a pressurized cabin altitude does have some effects on the human body.
Air travel may pose a special form of altitude problem since almost all commercial aircraft fly above 21,000
feet. Aircraft cabins are normally pressurized at a maximum of 8,000 feet (2438m). The falling barometric
pressure with increasing altitude results in a drop in arterial oxygen tensions (PaO2). However, air travel
offers many advantages for heart and lung patients since it is quick and involves little activity.
In general, airlines do allow oxygen to be used but require considerable forethought and planning. Arrangements
must be made in advance and most airlines require a doctor’s letter. A physician’s statement of oxygen needs
in order to fly in a commercial flights must be made available. Patients/passengers cannot bring their own
oxygen on board, oxygen supplied by the airline must be used. Requirements vary from carrier to carrier but,
they all require arrangements be made in advance and they all charge for in flight oxygen.
The airlines’ position on routine use of their oxygen in the transport of patients is that they are not in the
business of transporting sick people. There are unique liability problems in so doing and regulations which
must be followed when they act in the position of an air ambulance.
Patients with respiratory disorders such chronic obstructive pulmonary disease (COPD), cystic fibrosis,
asthma, or heart disease and need oxygen supply, they should be able to travel via air so long as they consult
closely with their physician and then follow the advice received.
For COPD patients, whose main problem is moving air in and out of their lungs, getting sufficient oxygen is
vital. Therefore, it is important that nothing be undertaken which inhibits its function. When travelling by car,
train, or bus, COPD patients and others needing supplementary oxygen should have a supply available in case
they pass through areas of excess air pollution. They should also avoid travel in a confined area, such a bus
where smoking in permitted, and ensure that they keep out of extreme temperatures, both hot and cold.
References
1. Aina Akero, Carl C. Christensen, Anne Edvardsen et al. Pulse oxymetry in the Preflight Evaluation of Patients with Chronic
Obstructive Pulmonary Disease. Aviation, Space and Environmental Medicine. Vol. 79. No. 5. May 2008
2. Medical Guidelines For Airline Travel 2nd Edition. Aerospace Medical Association Medical Guidelines Task Force, Alexandria, VA
3. J. Micheal Muhm. Predicted Arterial Oxygen at Commercial Aircraft Cabin Altitudes. Aviation, Space, and Environmental Medicine.
Vol. 75, No. 10. October 2004
4. Communication: Dr. Daljit Singh Parmar, Head of Corporate Occupational Safety and Health (COSH), Senior Manager Medical
Services, Malaysian Airlines System
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