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Managing patients with stable respiratory disease planning air travel: a primary care summary of the British Thoracic Society recommendations.

Abstract

Air travel poses medical challenges to passengers with respiratory disease, principally because of exposure to a hypobaric environment. In 2002 the British Thoracic Society published recommendations for adults and children with respiratory disease planning air travel, with a web update in 2004. New full recommendations and a summary were published in 2011, containing key recommendations for the assessment of high-risk patients and identification of those likely to require in-flight supplemental oxygen. This paper highlights the aspects of particular relevance to primary care practitioners with the following key points: (1) At cabin altitudes of 8000 feet (the usual upper limit of in-flight cabin pressure, equivalent to 0.75 atmospheres) the partial pressure of oxygen falls to the equivalent of breathing 15.1% oxygen at sea level. Arterial oxygen tension falls in all passengers; in patients with respiratory disease, altitude may worsen preexisting hypoxaemia. (2) Altitude exposure also influences the volume of any air in cavities, where pressure x volume remain constant (Boyle's law), so that a pneumothorax or closed lung bulla will expand and may cause respiratory distress. Similarly, barotrauma may affect the middle ear or sinuses if these cavities fail to equilibrate. (3) Patients with respiratory disease require clinical assessment and advice before air travel to: (a) optimise usual care; (b) consider contraindications to travel and possible need for in-flight oxygen; (c) consider the need for secondary care referral for further assessment; (d) discuss the risk of venous thromboembolism; and (e) discuss forward planning for the journey.

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  • Authors+Show Affiliations

    ,

    Primary Care Research, Aldermoor Health Centre, University of Southampton, Southampton, UK. L.Josephs@soton.ac.uk

    , , ,

    Source

    MeSH

    Adult
    Aircraft
    Asthma
    Child
    Humans
    Infant
    Pneumothorax
    Pulmonary Disease, Chronic Obstructive
    Respiratory Tract Diseases
    Respiratory Tract Infections
    Respiratory Tract Neoplasms
    Sleep Apnea Syndromes
    Travel
    Travel Medicine
    Venous Thromboembolism

    Pub Type(s)

    Journal Article
    Practice Guideline

    Language

    eng

    PubMed ID

    23732637

    Citation

    Josephs, Lynn K., et al. "Managing Patients With Stable Respiratory Disease Planning Air Travel: a Primary Care Summary of the British Thoracic Society Recommendations." Primary Care Respiratory Journal : Journal of the General Practice Airways Group, vol. 22, no. 2, 2013, pp. 234-8.
    Josephs LK, Coker RK, Thomas M, et al. Managing patients with stable respiratory disease planning air travel: a primary care summary of the British Thoracic Society recommendations. Prim Care Respir J. 2013;22(2):234-8.
    Josephs, L. K., Coker, R. K., & Thomas, M. (2013). Managing patients with stable respiratory disease planning air travel: a primary care summary of the British Thoracic Society recommendations. Primary Care Respiratory Journal : Journal of the General Practice Airways Group, 22(2), pp. 234-8. doi:10.4104/pcrj.2013.00046.
    Josephs LK, et al. Managing Patients With Stable Respiratory Disease Planning Air Travel: a Primary Care Summary of the British Thoracic Society Recommendations. Prim Care Respir J. 2013;22(2):234-8. PubMed PMID: 23732637.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Managing patients with stable respiratory disease planning air travel: a primary care summary of the British Thoracic Society recommendations. AU - Josephs,Lynn K, AU - Coker,Robina K, AU - Thomas,Mike, AU - ,, AU - ,, PY - 2013/6/5/entrez PY - 2013/6/5/pubmed PY - 2014/2/11/medline SP - 234 EP - 8 JF - Primary care respiratory journal : journal of the General Practice Airways Group JO - Prim Care Respir J VL - 22 IS - 2 N2 - Air travel poses medical challenges to passengers with respiratory disease, principally because of exposure to a hypobaric environment. In 2002 the British Thoracic Society published recommendations for adults and children with respiratory disease planning air travel, with a web update in 2004. New full recommendations and a summary were published in 2011, containing key recommendations for the assessment of high-risk patients and identification of those likely to require in-flight supplemental oxygen. This paper highlights the aspects of particular relevance to primary care practitioners with the following key points: (1) At cabin altitudes of 8000 feet (the usual upper limit of in-flight cabin pressure, equivalent to 0.75 atmospheres) the partial pressure of oxygen falls to the equivalent of breathing 15.1% oxygen at sea level. Arterial oxygen tension falls in all passengers; in patients with respiratory disease, altitude may worsen preexisting hypoxaemia. (2) Altitude exposure also influences the volume of any air in cavities, where pressure x volume remain constant (Boyle's law), so that a pneumothorax or closed lung bulla will expand and may cause respiratory distress. Similarly, barotrauma may affect the middle ear or sinuses if these cavities fail to equilibrate. (3) Patients with respiratory disease require clinical assessment and advice before air travel to: (a) optimise usual care; (b) consider contraindications to travel and possible need for in-flight oxygen; (c) consider the need for secondary care referral for further assessment; (d) discuss the risk of venous thromboembolism; and (e) discuss forward planning for the journey. SN - 1475-1534 UR - https://www.unboundmedicine.com/medline/citation/23732637/full_citation L2 - https://dx.doi.org/10.4104/pcrj.2013.00046 DB - PRIME DP - Unbound Medicine ER -