Air travel in women with Lymphangioleiomyomatosis

Stacey M Pollock-BarZiv ^1*, Marsha M Cohen ², Gregory P. Downey ², Simon R Johnson ³, Eugene Sullivan ⁴ and Francis X McCormack ⁵

¹ The Hospital for Sick Children, Canada
² University of Toronto, Canada
³ University of Nottingham, United Kingdom
⁴ US Food and Drug Administration, United States
⁵ University of Cincinnati Medical Center, United States

^* To whom correspondence should be addressed. E-mail: s.pollock.barziv{at}utoronto.ca.

Accepted 31 August 2006

Abstract

Background: There has been little study of the safety of air travel in patients with pneumothorax-prone pulmonary diseases such as lymphangioleiomyomatosis (LAM). A questionnaire based evaluation of air travel in LAM patients 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 United Kingdom 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: A total of 327 women completed the survey (73%). 308 women answered the travel section, of whom 276 (90%) had ‘ever’ traveled by airplane for 454 flights. Ninety-five women (35%) had been advised by their doctor to avoid air travel. Adverse events reported include shortness of breath (14%), pneumothorax (2% - 8/10 confirmed by chest x-ray), nausea or dizziness (8%), chest pain (12%), unusual fatigue (11%), oxygen desaturation (8%), headache (9%), blue hands (2%), hemoptysis (0.4%), and anxiety (22%). Five of ten patients with pneumothoraces had symptoms that began prior to the flight; 2 occurred during cruising altitude, 2 soon after landing, 1 not known. The main symptoms were severe chest pain and shortness of breath.

Discussion: Adverse effects occurred during air travel with LAM, particularly dyspnea and chest pain. Hypoxemia and pneumothorax were reported. The decision to travel should be individualized; patients with unexplained shortness of breath or chest pain prior to scheduled flights should not board. Patients with borderline oxygen saturations on the ground should be evaluated for supplemental oxygen therapy during flight. While many women had been advised not to use air travel, most traveled without the occurrence of serious adverse effects.

Keywords: air travel, lymphangioleiomyomatosis, pneumothorax

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