MISCELLANEOUS

Air travel in women with lymphangioleiomyomatosis

Stacey Pollock-BarZiv¹, Marsha M Cohen², Gregory P Downey³, Simon R Johnson⁴, Eugene Sullivan⁵, Francis X McCormack⁶

¹ Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
² Department of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
³ Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
⁴ Division of Therapeutics and Molecular Medicine, The University of Nottingham, Nottingham, UK
⁵ Chief Medical Officer, Lung Rx, Silver Spring, Maryland, USA
⁶ Division of Pulmonary & Critical Care Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA

Correspondence to:
Dr S Pollock-BarZiv
Division of Cardiology, Cardiac Transplant, Room 6429, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8; s.pollock.barziv{at}utoronto.ca

Background and objective: The safety of air travel in patients with pneumothorax-prone pulmonary diseases, such as lymphangioleiomyomatosis (LAM), has not been studied to any great extent. A questionnaire-based evaluation of air travel in patients with LAM was conducted to determine experiences aboard commercial aircraft.

Methods: A survey was sent to women listed in the US LAM Foundation registry (n = 389) and the UK LAM Action registry (n = 59) to assess air travel, including problems occurring during flight. Women reporting a pneumothorax in flight were followed up to ascertain further details about the incident.

Results: 327 (73%) women completed the survey. 308 women answered the travel section, of whom 276 (90%) had "ever" travelled by aeroplane for a total of 454 flights. 95 (35%) women had been advised by their doctor to avoid air travel. Adverse events reported included shortness of breath (14%), pneumothorax (2%, 8/10 confirmed by chest radiograph), nausea or dizziness (8%), chest pain (12%), unusual fatigue (11%), oxygen desaturation (8%), headache (9%), blue hands (2%), haemoptysis (0.4%) and anxiety (22%). 5 of 10 patients with pneumothorax had symptoms that began before the flight: 2 occurred during cruising altitude, 2 soon after landing and 1 not known. The main symptoms were severe chest pain and shortness of breath.

Discussion and conclusion: Adverse effects occurred during air travel in patients with LAM, particularly dyspnoea and chest pain. Hypoxaemia and pneumothorax were reported. The decision to travel should be individualised; patients with unexplained shortness of breath or chest pain before scheduled flights should not board. Patients with borderline oxygen saturations on the ground should be evaluated for supplemental oxygen therapy during flight. Although many women had been advised not to travel by air, most travelled without the occurrence of serious adverse effects.

Abbreviations: LAM, lymphangioleiomyomatosis; PaO₂, arterial oxygen pressure; TSC, tuberous sclerosis

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