Article by Dr John Blakey and Dr Alice Crawford, Respiratory Physicians.

Over the last couple of years, we have been restricted in our movements because of the coronavirus pandemic. However, with borders opening and restrictions lifting, many of us will be looking to fly off on holiday, or to visit family and friends.  However, travelling by plane can be a problem for some people with chronic respiratory disease.

What’s the issue?

Air travel is generally safe for people with lung disease, but a decision to fly shouldn’t be undertaken lightly. Aside from the hassle of having to travel with inhalers or specialist medicines, a more important issue can be the pressure in commercial airliners. Most planes have an oxygen level about the same as you’d find if you were outside at 8,000 feet (2,438m). That’s higher than the tallest mountain in Australia. The low oxygen level isn’t the only issue, as the pressure changes you experience when your ears “pop” can also affect the lungs.

Passport, tickets, oxygen?

There are clear guidelines for who should get tested before they fly, and what tests should be done to decide if supplemental oxygen is required. These are slightly different for different lung diseases, and specific advice will depend on the duration and destination of the flights, so a medical review is essential. However, there are some common aspects:

  • Stop smoking: it’s important that anybody who smokes makes a strenuous attempt to stop. Apart from its many other damaging effects, cigarette smoke reduces the number of red blood cells that are available to carry oxygen.
  • Be as good as you can be: it’s important that before flying people are in the best shape possible. This usually includes having your medicines reviewed by your doctor, ensuring that you have taken all of the prescribed doses of regular preventative treatment, and remembering to do any physiotherapy or clearance exercises.
  • Consider simple screening tests: for people with chronic lung disease and breathlessness on exertion, a GP or specialist can do a simple screening test by checking your oxygen saturation (finger probe sats). If these are normal at rest and when you’re walking it’s unlikely that you would require any oxygen on a plane.
  • Go for a high altitude test if it is recommended: a high-altitude simulation test (“hypoxic challenge test”) involves breathing air with a lower percentage of oxygen to simulate being on a plane. This is done if it is uncertain whether you will need supplemental oxygen on a plane, or if it is not clear how much extra oxygen you will need. The test is usually undertaken in the lung function laboratory in a hospital and will be only ordered by a specialist respiratory doctor.
  • Air pressure problems: Some people are less at risk from the lower oxygen levels but rather from the change in air pressure. If you have ever been told you have lung cysts, or have had a collapsed lung or fluid under the lung ( pleural effusion) recently you must talk to the specialist looking after you before you fly.
  • If in doubt, ask: the rules are different for people with some uncommon kinds of respiratory disease. If you are uncertain whether you might need extra oxygen on a plane, please do ask your respiratory specialist. This is also essential for children with severe lung disease.

What if I already have oxygen at home?

Hundreds of people in the State already have oxygen at home because of chronic lung disease. For many of these people, it is fine to fly after the advice of your specialist. Usually, people have in-flight oxygen at two litres per minute higher than their usual prescription on the ground, but this will depend on the type of problem you have.

Key Reference: Coker et al Thorax 2022; 77: 329-350

Information is general only. Before travelling, speak to your GP or specialist respiratory doctor to determine what’s best for your unique situation.

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