Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung condition characterized by restricted airflow and breathing difficulties, encompassing diseases like emphysema and chronic bronchitis. These conditions cause damage to the airways and air sacs, leading to inadequate gas exchange and persistent symptoms such as shortness of breath and a chronic cough. Flying commercially is possible for many with COPD, but it requires significant medical assessment and careful logistical preparation. The decision to fly should never be made without a thorough consultation with a healthcare provider, specifically a pulmonologist, to evaluate individual risk factors.
The Physiological Impact of Cabin Pressure
The primary concern for COPD patients flying commercially stems from the unique atmospheric conditions inside the aircraft cabin. While the plane flies at high altitudes, the cabin is artificially pressurized to protect passengers and crew. This pressurization, however, does not maintain sea-level conditions and is typically equivalent to an altitude of 5,000 to 8,000 feet above sea level.
This simulated altitude causes a reduction in the barometric pressure within the cabin, which in turn lowers the partial pressure of oxygen available for the lungs to absorb. Although the air still contains the same percentage of oxygen, the decreased pressure means fewer oxygen molecules are pushed into the bloodstream. This effect is known as hypobaric hypoxia, and it places stress on the respiratory system.
For someone with COPD, whose lungs already struggle with gas exchange, this stress can lead to a significant drop in blood oxygen saturation (\(S_p\text{O}_2\)). A substantial decrease in \(S_p\text{O}_2\) can trigger severe symptoms, including confusion, chest pain, and cardiac events. Therefore, the assessment of in-flight oxygen needs is a central part of pre-travel planning for patients with limited cardiopulmonary reserve.
Assessing Fitness to Fly
Determining a patient’s fitness to fly begins with a comprehensive medical evaluation conducted by a respiratory specialist, ideally six to eight weeks before the planned travel date. This assessment establishes the patient’s baseline lung function and their likelihood of developing problematic hypoxemia during the flight. Patients with stable COPD whose resting oxygen saturation is 95% or higher on room air are generally considered low-risk and may not require further testing.
For patients whose resting oxygen saturation is between 92% and 95%, or those with more severe disease, a specialized test is necessary to predict in-flight oxygen requirements. The Hypoxia Altitude Simulation Test (HAST) is commonly used to simulate the cabin environment while the patient remains safely in the clinic. During the HAST, the patient breathes a gas mixture containing a reduced concentration of oxygen, typically 15%, for about 15 to 20 minutes. This gas concentration mimics the oxygen availability at a cabin altitude of 8,000 feet.
The patient’s blood oxygen saturation (\(S_p\text{O}_2\)) is continuously monitored throughout the HAST. If the saturation level falls below a predetermined threshold, often 85%, the test is positive, indicating a definite need for supplemental oxygen during the flight. A positive HAST allows the pulmonologist to precisely determine the flow rate of supplemental oxygen required to maintain a safe \(S_p\text{O}_2\) while airborne. The HAST results must be interpreted alongside the patient’s overall health status and other co-existing medical conditions.
Managing Oxygen and Medications During Flight
Once a medical assessment confirms the need for supplemental oxygen, the patient must coordinate the logistics of bringing their oxygen supply onto the aircraft. Patients cannot rely on the oxygen supply provided by the airline, as this is typically reserved for emergency use. The only acceptable method for providing personal oxygen during flight is through an FAA-approved Portable Oxygen Concentrator (POC).
Selecting an FAA-approved model is mandatory, and the patient must notify the airline at least 48 hours in advance of the flight. A physician’s statement or prescription is required by most airlines, confirming the need for a POC, the flow rate required, and the duration of use. This documentation ensures that the airline staff is prepared for the medical equipment and that the device meets their operational safety standards.
Power Supply Requirements
A significant logistical challenge is managing the power supply for the POC, as airlines do not permit the use of in-flight power outlets to run the device. The Federal Aviation Administration (FAA) requires travelers to carry enough fully charged batteries to power the POC for 150% of the expected maximum flight duration. For instance, a four-hour flight requires a minimum of six hours of battery life to account for delays and unforeseen circumstances. All spare lithium batteries must be carried in carry-on baggage, not checked baggage, and must be individually protected to prevent short circuits. Furthermore, lithium-ion batteries for POCs are subject to a maximum limit of 160 Watt-hours (Wh).
Medications and Action Plan
In addition to oxygen, all personal medications, especially emergency rescue medications, must be readily accessible in carry-on luggage. Rescue inhalers, oral steroids, and any other medications used to manage a COPD flare-up should be kept close at hand during the flight and throughout the trip. Having a clear, written COPD action plan and a list of all medications is also a prudent measure in case medical assistance is needed while traveling.
Warning Signs and When to Avoid Travel
Despite careful planning, there are specific acute medical conditions that make air travel unsafe and should result in the postponement of the trip. A recent COPD exacerbation, defined as a flare-up requiring hospitalization or a change in medication, is a contraindication to flying. Travel should be delayed until the patient’s condition has stabilized, and their use of reliever therapy has returned to their usual baseline.
Patients who have experienced a recent pneumothorax, or collapsed lung, should not fly until they have been medically cleared, as the pressure changes in the cabin can cause the air pocket to expand. Uncontrolled pulmonary hypertension or a severe respiratory infection, such as pneumonia, also increases the risk of complications at altitude and necessitates delaying travel.
COPD patients are at an increased risk for developing deep vein thrombosis (DVT), and the prolonged immobility of a long flight further elevates this risk. Taking precautions against DVT, such as wearing compression stockings and moving around the cabin when possible, is a necessary safety measure for long-haul flights.