Pulmonary fibrosis (PF) is a progressive condition characterized by the scarring and thickening of tissue within the lungs. This fibrosis makes the lungs stiff and less able to transfer oxygen efficiently from the air sacs into the bloodstream, resulting in shortness of breath. For individuals managing PF, the prospect of air travel is often a significant concern due to the unique environment of an airplane cabin. While the decision to fly requires careful consideration, most patients can travel safely with thorough medical planning and preparation.
The Physiological Impact of Reduced Cabin Pressure
Commercial aircraft cabins are pressurized, but they simulate an altitude between 6,000 and 8,000 feet above sea level. This simulated altitude causes a measurable drop in the available oxygen compared to what a person breathes on the ground. For healthy passengers, this slight reduction is usually inconsequential, resulting in only a minor dip in blood oxygen saturation (SpO2).
However, for someone with pulmonary fibrosis, whose lungs are already struggling with gas exchange, this lower partial pressure of oxygen can lead to hypoxemia. Hypoxemia is a severe drop in blood oxygen levels, which can cause symptoms like extreme fatigue, confusion, and increased shortness of breath. This effect is often magnified by the minimal exertion required for walking or retrieving carry-on items during the flight.
Mandatory Pre-Flight Medical Assessment
Before booking any flight, a patient with pulmonary fibrosis must consult their treating pulmonologist to determine their fitness to fly. This consultation should happen four to six weeks before the planned departure date to allow time for necessary testing and paperwork. The goal of this assessment is to predict whether the patient will experience a dangerous drop in blood oxygen saturation at cruising altitude.
The gold standard for this prediction is the Hypoxia Altitude Simulation Test (HAST). During the HAST, the patient breathes a gas mixture containing approximately 15% oxygen, which mimics the lowest oxygen concentration found in an aircraft cabin. The patient’s SpO2 is continuously monitored while they are at rest and sometimes while performing a small amount of exercise. If the blood oxygen saturation drops below 90% during the test, the physician determines the exact flow rate of supplemental oxygen needed to maintain a safe level during the flight. The results of this test are then used to obtain a medical clearance letter, which confirms the patient is fit for travel and specifies the required oxygen flow rate.
Navigating In-Flight Oxygen Requirements
When supplemental oxygen is required, patients cannot bring their own compressed oxygen tanks or liquid oxygen systems onto a commercial flight, as these are classified as hazardous materials. The Federal Aviation Administration (FAA) mandates the use of only specific models of Portable Oxygen Concentrators (POCs) approved for in-flight use. These devices must bear a manufacturer’s label confirming they meet FAA requirements.
A POC filters nitrogen from the air to deliver a higher concentration of oxygen. The flow rate needed at altitude is often higher than the rate used at home. The most critical logistical requirement is the battery supply, which must be sufficient to power the POC for at least 150% of the expected total travel time. This calculation must account for the duration of the flight, plus any ground delays and layovers.
Airline Policies and Travel Day Logistics
Successful air travel requires strict adherence to airline administrative rules in addition to medical preparation. Passengers planning to use a POC must notify the airline at least 48 hours before departure. This notification allows the airline to verify the POC model and ensure arrangements are in place.
The required documentation, including the physician’s medical clearance and prescription for the oxygen flow rate, must be readily available and presented to the airline staff. Since the POC is classified as an assistive medical device, it does not count against a passenger’s carry-on baggage allowance. Early arrival at the airport is advisable to allow time for the airline to inspect the equipment and documentation.
Battery Requirements
- All spare batteries must be carried in the cabin, not in checked luggage.
- Batteries should be protected from short-circuiting.
- Protection can be achieved by keeping them in their original packaging.
- A protective case may also be used for storage.