Medical Advice for Commercial Air Travel

 

Air travel is generally safe, but the flight environment poses unique physiologic challenges such as relative hypoxia that may trigger adverse myocardial or pulmonary outcomes. To optimize health outcomes, communication must take place between the traveler, family physician, and airline carrier when there is any doubt about fitness for air travel. Travelers should carry current medications in their original containers and a list of their medical conditions and allergies; they should adjust timing of medications as needed based on time zone changes. The Hypoxia Altitude Simulation Test can be used to determine specific in-flight oxygen requirements for patients who have pulmonary complications or for those for whom safe air travel remains in doubt. Patients with pulmonary conditions who are unable to walk 50 m or for those whose usual oxygen requirements exceed 4 L per minute should be advised not to fly. Trapped gases that expand at high altitude can cause problems for travelers with recent surgery; casting; ear, nose, and throat issues; or dental issues. Insulin requirements may change based on duration and direction of travel. Travelers can minimize risk for deep venous thrombosis by adequately hydrating, avoiding alcohol, walking for 10 to 15 minutes every two hours of travel time, and performing seated isometric exercises. Wearing compression stockings can prevent asymptomatic deep venous thrombosis and superficial venous thrombosis for flights five hours or longer in duration. Physicians and travelers can review relevant pretravel health information, including required and recommended immunizations, health concerns, and other travel resources appropriate for any destination worldwide on the Centers for Disease Control and Prevention travel website.

Air travel has become increasingly popular over time, despite decreases during the COVID-19 pandemic, with 1.1 billion total passengers in 2019 and most Americans having flown at least once in the past three years.1 Air travel is generally safe, but especially for the aging U.S. population, the flight environment poses unique physiologic challenges, particularly relative hypoxia, which may trigger adverse myocardial or pulmonary outcomes. To optimize health outcomes, communication must take place between the traveler, family physician, and airline carrier when any doubt occurs about fitness for air travel. Travelers should carry current medications in their original containers as well as a list of their medical conditions and allergies and should adjust timing of medications as needed based on time zone changes. Travelers should also consider available medical resources at their travel destinations and layover locations. Family physicians and travelers can review relevant pretravel health information, including required and recommended immunizations, health concerns, and other travel resources appropriate for any destination worldwide at https://wwwnc.cdc.gov/travel/destinations/list.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Patients with stable angina triggered by minimal exertion should be evaluated for oxygen needs and any other special assistance before flight.11

C

Consensus/expert opinion

Patients with unstable angina, new cardiac or pulmonary symptoms, or recent changes in medications without appropriate follow-up should not fly until stable.11

C

Consensus/expert opinion

Travelers at low risk with a recent myocardial infarction should defer air travel for three to 10 days postevent.1115

C

Consensus/expert opinion; smaller studies looking at travel after two weeks or longer

Transdermal scopolamine can prevent air sickness, but patients should be counseled on adverse effects of drowsiness, blurry vision, dry mouth, or dizziness.22

B

Cochrane review of variable-quality randomized controlled trials

Insulin requirements may change based on the direction of travel and crossing time zones; fast-acting insulin should be considered for all travelers during flight due to its flexibility and responsiveness.23

C

Consensus/expert opinion

Compression stocking use in flights lasting at least five hours can prevent asymptomatic deep venous thrombosis and superficial venous thrombosis.27

A

Cochrane review

Patients with an uncomplicated singleton pregnancy generally should not fly beyond 36 weeks of estimated gestational age7,24,33,34 and those with a multiple gestation not beyond 32 weeks.34

C

Consensus opinion


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Patients with stable angina triggered by minimal exertion

The Authors

show all author info

NICOLE POWELL-DUNFORD, MD, MPH, MPD, FAAFP, FAsMA, is a faculty member at the School of Army Aviation Medicine, Fort Rucker, Ala., and an associate professor of Military and Emergency Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md....

JOSEPH R. ADAMS, DO, MPH, is a resident in the Department of Aerospace Medicine at the School of Army Aviation Medicine.

CHRISTOPHER GRACE, DO, MPH, is a resident in the Department of Aerospace Medicine at the School of Army Aviation Medicine.

Address correspondence to Nicole Powell-Dunford, MD, MPH, MPD, FAAFP, FAsMA, 47 Red Cloud Rd., Fort Rucker, AL 36362 (email: nikkipd@gmail.com). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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