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Managing passengers with stable respiratory disease planning air travel: British Thoracic Society recommendations
  1. S Ahmedzai1,
  2. I M Balfour-Lynn2,
  3. T Bewick3,
  4. R Buchdahl4,
  5. R K Coker, (chair)5,
  6. A R Cummin6,
  7. D P Gradwell7,
  8. L Howard8,
  9. J A Innes9,
  10. A O C Johnson10,
  11. E Lim11,
  12. Wei Shen Lim12,
  13. K P McKinlay13,
  14. M R Partridge14,
  15. M Popplestone15,
  16. A Pozniak16,
  17. A Robson17,
  18. C L Shovlin18,
  19. D Shrikrishna19,
  20. A Simonds19,
  21. P Tait21,
  22. M Thomas20 On behalf of the British Thoracic Society Standards of Care Committee
  1. 1School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK
  2. 2Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
  3. 3Respiratory Medicine, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
  4. 4Paediatrics, Hillingdon Hospital NHS Trust, Uxbridge, Middlesex, UK
  5. 5Respiratory Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
  6. 6Respiratory Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
  7. 7RAF Centre of Aviation Medicine, Hitchin, Hertfordshire, UK
  8. 8National Pulmonary Hypertension Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
  9. 9Respiratory Unit, Western General Hospital, Edinburgh, UK
  10. 10Respiratory Medicine, Pontefract General Infirmary, Pontefract, Yorkshire, UK
  11. 11Thoracic Surgery, Royal Brompton Hospital, London, UK
  12. 12Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
  13. 13Respiratory Medicine, North Hampshire Hospital, Basingstoke, Hampshire, UK
  14. 14NHLI at Charing Cross, Imperial College London, London, UK
  15. 15Virgin Atlantic Airways, Crawley, Surrey, UK
  16. 16Chelsea and Westminster HIV Department, Chelsea and Westminster NHS Foundation Trust, London, UK
  17. 17Respiratory Function Service, Western General Hospital, Edinburgh, UK
  18. 18NHLI at Hammersmith, Imperial College London, London, UK
  19. 19Respiratory Medicine, Royal Brompton Hospital, London, UK
  20. 20The UK Confidential Reporting Programme for Aviation and Maritime, Farnborough, Hampshire, UK
  21. 21Aberdeen University, Aberdeen, Scotland
  1. Correspondence to Dr Robina Kate Coker, Respiratory Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, W12 0HS, UK; robina.coker{at}

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Need for new recommendations for managing passengers with respiratory disease planning air travel

Since the first British Thoracic Society (BTS) recommendations published in 20021 and web update in 2004,2 data from several studies have confirmed previous findings suggesting that neither resting sea level oxygen saturations nor forced expiratory volume in 1 s (FEV1) reliably predict hypoxaemia or complications of air travel in passengers with respiratory disease.3–7 It is thus now clear that there is no reliable threshold in these variables to determine accurately the safety of air travel or need for in-flight oxygen in an individual patient. Nevertheless, the need for practical recommendations remains. The new guidance covers bronchiectasis, cancer, hyperventilation and dysfunctional breathing, obesity, pulmonary arteriovenous malformations and sinus and middle ear disease, and has expanded sections on infection and comorbidity with cardiac disease.

UK airports handled over 235 million passengers in 20088 and around 2 billion passengers flew in 2006, 760 million worldwide.9 The average age of passengers is likely to rise, making comorbidity more likely. Over 30 years ago around 5% of commercial airline passengers were thought to have a pre-existing medical condition.10 With new ultra-long haul flights, passengers are exposed to cabin altitudes of up to 8000 ft for up to and sometimes more than 20 h. Longer journeys increase the odds of in-flight medical incidents, and physiological disturbances associated with moderate but prolonged hypoxia, prolonged immobility and protracted exposure to reduced barometric pressure are unknown. Longer flights may increase the risk of desaturation, perhaps reflecting a gradual fall in cabin oxygen pressure.11

There are no established methods for quantifying in-flight medical emergencies.12 A North American service offering radio link assistance for in-flight medical emergencies logs over 17 000 calls a year; respiratory events accounted for 10–12% of such calls from 2004 to 2008, the third most frequent diagnostic category (Dr Paulo Alves, MedAire Inc, …

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  • Disclaimer Healthcare providers need to use clinical judgement, knowledge and expertise when deciding whether it is appropriate to apply recommendations for the management of patients. The recommendations cited here are a guide and may not be appropriate for use in all situations. The decision to adopt any of the recommendations cited here must be made by the practitioner in light of individual patient circumstances, the wishes of the patient, clinical expertise and resources. The British Thoracic Society disclaims any responsibility for damages arising out of the use or non-use of these recommendations and the literature used in support of these recommendations.

  • Funding Preparation and publication of the document were paid for by the British Thoracic Society with no external funding.

  • Competing interests All members of the Air Travel Working Party have submitted a written record of possible conflicts of interest to the British Thoracic Society Standards of Care Committee. These are available for inspection on request from the Chairman of this Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.