MANAGING PASSENGERS WITH RESPIRATORY BRITISH THORACIC SOCIETY RECOMMENDATIONS DISEASE PLANNING AIR TRAVEL:

Transcription

1 MANAGING PASSENGERS WITH RESPIRATORY DISEASE PLANNING AIR TRAVEL: BRITISH THORACIC SOCIETY RECOMMENDATIONS Andy Robson Edinburgh Respiratory Function Service

2

3 The story so far : BTS Standards of care committee commissioned an air travel working party to formulate recommendations for managing passengers with lung disease who were planning air travel. Thorax 57 (2002) Recommendations revisited and updated in 2004: available online.

4 The story so far : Working party reconvenes for second revision. Working draft completed late 2009, launched at Winter BTS meeting. To be distributed to a number of stakeholders, including ARTP, BMA, BLF. Final version of guidelines to be published in Thorax.

5 What has changed? More published data on preflight assessments, including new techniques

6 What has changed?

7 What has changed? Most hypoxic challenges are 20 minutes in duration. How can this translate to a transatlantic flight? Akerø et al. (Eur Respir. J. (2005) 25: ) recorded PaO 2 during a 6 hour commercial flight in COPD patients. Results were stable once cruising altitude had been reached.

8 BTS Recommendations Result of hypoxic challenge Recommendation SpO 2 >85% PaO 2 >6.6 kpa No need for in-flight O 2 SpO 2 < 85% PaO 2 <6.6 kpa Supplemental O 2 2 litres/minute

9 BTS Recommendations Hypoxic challenge in infants Premature infants with no respiratory disease do not require hypoxic challenge, but supplemental oxygen should be available if they become symptomatic. Infants with chronic respiratory problems require hypoxic challenge and should travel with supplemental O 2 if SpO 2 <85%.

10 2010 BTS Recommendations Number of new sections: Cancer Cardiac disease Dysfunctional breathing Obesity PAVM Sinus disease

11 2010 BTS Recommendations There are still some areas of interest with significant lack of published data. Some recommendations based on expert opinion, rather than available evidence.

12 2010 BTS Recommendations Cancer Refers to patients with thoracic lesions, but some general points can be made: Try to correct anaemia before travel. Patients with major airway obstruction should have had treatment completed before travel. Large pleural effusions drained. Patients with superior vena cava obstruction are at increased risk and should not travel alone.

13 2010 BTS Recommendations Cardiac disease BCS due to publish their own guidelines on travel with cardiac disease shortly. Patients with coronary artery disease are at a slightly increased risk due to hypoxic environment. Wait 5 10 days after MI before flight. Wait 14 days after CABG, as long as no other contraindications Patients with severe angina (CCS class IV) should be advised against air travel.

14 Heart failure 2010 BTS Recommendations Cardiac disease NYHA class 1 3 patients without pulmonary hypertension should be able to fly without supplemental oxygen. NYHA class 4 patients should be advised against air travel. Pulmonary hypertension NYHA classes 1 & 2: No supplemental oxygen NYHA classes 3 & 4: Supplemental oxygen

15 2010 BTS Recommendations Dysfunctional breathing Patients with HVS should have an assessment before travel by a clinician skilled in managing these disorders.

16 2010 BTS Recommendations Obesity Patients with BMI >30 at increased risk of thromboembolism during longer flights.? Pretreatment with anticoagulants.

17 2010 BTS Recommendations Pulmonary arteriovenous malformations If patient is undergoing, or is to receive embolisation treatment this should take place before air travel. PAVM patients who are hypoxic at rest should only fly if essential and should take heparin before flight.

18 2010 BTS Recommendations Sleep apnoea Patients with OSA may be able to use CPAP devices during flight if they are battery operated. If patients are intending to use CPAP during flight they are advised to contact the airline well in advance of travel to confirm arrangements. More AC power points available on newer aircraft types.

19 2010 BTS Recommendations Pneumothorax Wait for one week after complete resolution of spontaneous pneumothorax. Two weeks may be more appropriate after traumatic pneumothorax. Open surgical treatment best option for passengers with recurrent pneumothorax.

20 2010 BTS Recommendations Sinus Disease May be more clinically important than many lower respiratory tract conditions. Barotrauma can cause significant distress for a number of passengers. Both preflight and inflight treatment indicated.

21 The Future More research required, looking at a range of lung conditions, not just COPD. More flight outcome assessments. What constitutes clinically significant desaturation?

22 Take Home Messages Assess patients on an individual basis. Not all patients require extensive preflight assessment. Some patients should be advised against flight. Patients requiring supplemental oxygen or to use CPAP devices should contact airlines well in advance to confirm arrangements.

23 Thank you for your attention