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Chronic obstructive pulmonary disease - Management
Fitness-to-fly assessment

  • If a person has respiratory disease, the only absolute contraindications to air travel are:
    • Pneumothorax — airline companies suggest waiting 6 weeks after recovering from a pneumothorax before flying.
    • Bronchogenic cyst.
    • Severe pulmonary hypertension.
    • Clinically unstable respiratory disease.
  • The aim of pre-flight assessment is to identify people who are likely to develop respiratory symptoms (such as hypoxia) during air travel. The two main methods of pre-flight assessment are:
    • The walking test — this is a good measure of cardiopulmonary reserve to exercise (although it is not always feasible to do this at the GP's surgery).
      • The 50-metre walking test was put forward by the airline industry and involves asking the person whether they can walk for 50 metres on the flat. The 50-metre walking test has not yet been standardized and can be inaccurate, as many people cannot accurately assess distance.
      • The 6-minute walking test (which involves asking the person to walk for 6 minutes) is a standardized and validated test recommended by the British Thoracic Society to evaluate the fitness to fly in people with COPD.
      • If the person can perform the walking test, they are probably fit to travel. However, if the person cannot complete the test or develops severe breathlessness, further tests are needed, as they may require oxygen supplementation during the flight.
    • Pulse oximetry — saturation measured by pulse oximetry can be used to identify people who will definitely require oxygen supplementation during the flight.
      • If the person's oxygen saturation is 95% or greater, they do not need oxygen for flying, and there is no need for a referral to a respiratory specialist.
      • If the person's oxygen saturation is 92% or less and they have no other contraindications, they must travel with supplemental oxygen. Refer to a respiratory specialist for assessment for supplemental oxygen.
      • If the person's oxygen saturation is greater than 92% but less than 95%, they should be referred to a respiratory specialist for further evaluation. This may include a hypoxic challenge test, after which a decision will be made on whether oxygen is required while flying.
  • A fitness-to-fly assessment should also include taking a history focusing on previous flying experience — this will help identify ways to make the flight as comfortable as possible for the person.

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