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Managing patients with stable respiratory disease planning air travel: a primary care summary of the British Thoracic Society recommendations

Managing patients with stable respiratory disease planning air travel: a primary care summary of the British Thoracic Society recommendations
Managing patients with stable respiratory disease planning air travel: a primary care summary of the British Thoracic Society recommendations
Air travel poses medical challenges to passengers with respiratory disease, principally because of exposure to a hypobaric environment. In 2002 the British Thoracic Society published recommendations for adults and children with respiratory disease planning air travel, with a web update in 2004. New full recommendations and a summary were published in 2011, containing key recommendations for the assessment of high-risk patients and identification of those likely to require in-flight supplemental oxygen. This paper highlights the aspects of particular relevance to primary care practitioners with the following key points: (1) At cabin altitudes of 8000 feet (the usual upper limit of in-flight cabin pressure, equivalent to 0.75 atmospheres) the partial pressure of oxygen falls to the equivalent of breathing 15.1% oxygen at sea level. Arterial oxygen tension falls in all passengers; in patients with respiratory disease, altitude may worsen preexisting hypoxaemia. (2) Altitude exposure also influences the volume of any air in cavities, where pressure x volume remain constant (Boyle's law), so that a pneumothorax or closed lung bulla will expand and may cause respiratory distress. Similarly, barotrauma may affect the middle ear or sinuses if these cavities fail to equilibrate. (3) Patients with respiratory disease require clinical assessment and advice before air travel to: (a) optimise usual care; (b) consider contraindications to travel and possible need for in-flight oxygen; (c) consider the need for secondary care referral for further assessment; (d) discuss the risk of venous thromboembolism; and (e) discuss forward planning for the journey.
bts guideline, summary, air travel, respiratory diseases, primary care
1471-4418
234-238
Josephs, Lynn K.
865f1878-f0ca-42c3-a030-df6dcbc705b0
Coker, Robina K.
574cd215-5ceb-43d3-b4d4-393b13c7d3f5
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
on behalf of the BTS Air Travel Working Group
Josephs, Lynn K.
865f1878-f0ca-42c3-a030-df6dcbc705b0
Coker, Robina K.
574cd215-5ceb-43d3-b4d4-393b13c7d3f5
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953

Josephs, Lynn K., Coker, Robina K. and Thomas, Mike , on behalf of the BTS Air Travel Working Group (2013) Managing patients with stable respiratory disease planning air travel: a primary care summary of the British Thoracic Society recommendations. Primary Care Respiratory Journal, 22 (2), 234-238. (doi:10.4104/pcrj.2013.00046). (PMID:23732637)

Record type: Article

Abstract

Air travel poses medical challenges to passengers with respiratory disease, principally because of exposure to a hypobaric environment. In 2002 the British Thoracic Society published recommendations for adults and children with respiratory disease planning air travel, with a web update in 2004. New full recommendations and a summary were published in 2011, containing key recommendations for the assessment of high-risk patients and identification of those likely to require in-flight supplemental oxygen. This paper highlights the aspects of particular relevance to primary care practitioners with the following key points: (1) At cabin altitudes of 8000 feet (the usual upper limit of in-flight cabin pressure, equivalent to 0.75 atmospheres) the partial pressure of oxygen falls to the equivalent of breathing 15.1% oxygen at sea level. Arterial oxygen tension falls in all passengers; in patients with respiratory disease, altitude may worsen preexisting hypoxaemia. (2) Altitude exposure also influences the volume of any air in cavities, where pressure x volume remain constant (Boyle's law), so that a pneumothorax or closed lung bulla will expand and may cause respiratory distress. Similarly, barotrauma may affect the middle ear or sinuses if these cavities fail to equilibrate. (3) Patients with respiratory disease require clinical assessment and advice before air travel to: (a) optimise usual care; (b) consider contraindications to travel and possible need for in-flight oxygen; (c) consider the need for secondary care referral for further assessment; (d) discuss the risk of venous thromboembolism; and (e) discuss forward planning for the journey.

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More information

e-pub ahead of print date: 29 May 2013
Published date: June 2013
Keywords: bts guideline, summary, air travel, respiratory diseases, primary care
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 353841
URI: https://eprints.soton.ac.uk/id/eprint/353841
ISSN: 1471-4418
PURE UUID: 749c584d-408a-4608-9c31-abddb23ba604

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Date deposited: 20 Jun 2013 13:51
Last modified: 16 Jul 2019 21:30

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