Can you fly safely?

Travel of any sort can be a stressful experience for all, but there are special considerations for airline travel. Even prior to flying, one may have long distances to walk, baggage to carry, and encounter high levels of stress during air travel. While in flight, barometric pressure, noise, oxygen levels, or even the spaces where one sits all differ from what most people are familiar with.

The cramped aircraft cabin spaces make it difficult to move about freely. This immobility is known to increase the risk for medical conditions such as deep vein thrombosis or pulmonary embolus. Both of these life-threatening conditions are more likely as one’s blood thickness (viscosity) goes up but your entire blood volume goes down, thus making clotting more likely.  

Aircraft have less humidity, lower ambient pressure, and lower temperatures within the cabin than other environments. Compared to sea level, there is lower barometric air pressure, lower humidity, and lower oxygen content. 

The pressure within the aircraft cabin is equivalent to being at 5,000 to 8,000 feet of altitude.  At that altitude there is less available oxygen in the air for one to consume. Although airflow exchange within the cabin is reported to be three times the rate seen to control hospital room infections, cold flu and other viruses still likely remain on airplane surfaces.

None of the above are ideal for patients with certain medical conditions, and some of these conditions are disproportionately seen in people of color. They include heart disease, lung disease, diabetes, and blood vessel disease. All listed conditions may be worsened by air travel due to the changes in the environment listed above. 

Conditions such as hypertension, angina or diabetes can be challenging to manage as traveling across time zones will impact medication timing or availability. Time zone changes as one flies may cause “jet lag,” which presents as fatigue, difficulty sleeping, and sometimes confusion. All symptoms are similar to what is possible during poor blood sugar control, stroke, or blood pressure changes from baseline.

Additional conditions of note include any recent post-surgical patient; they have increased needs as a lower blood count, or anemia, sometimes due to a procedure’s blood loss, increases oxygen needs even more. 

Gastrointestinal issues are common during flight as trapped gasses expand in one’s gut as altitude increases. A recent abdominal surgery or colonoscopy both have the potential for gas to remain within enclosed body spaces immediately after the procedure. 

Flying soon after such procedures could cause gas expansion in one’s gastrointestinal tract. The recent procedures and lack of access to one’s regular diet may lead to extreme distress from gas pains.

Dehydration is also a common condition when flying due the lower cabin pressures and dry air, as the higher one goes the drier it gets. Blood pressure may also be elevated or decreased during air travel due to lower cabin pressures and the overall stressors of travel.

The consumption of caffeine and alcohol will cause additional drying of airways, skin or eyes. Drying of mucosal surfaces is irritating and will exacerbate coughs, cause severe cracks in skin, or even create issues with one’s contact lenses if worn.

In general, an individual with any unstable medical condition should get clearance from their physician prior to flying. Anyone with poor blood pressure control, asthma, emphysema, recent stroke, or recent surgical procedure (including ear or neurosurgical procedures) should make their provider aware that they are traveling.    

Special consideration should be taken with air travel during pregnancy, as the physiologic changes of pregnancy may increase the risk of DVT, cause premature delivery or placental issues. Abdominal trauma from the “lap belt” during turbulence could also be detrimental during flight.

Psychiatric conditions can also be worsened by airline travel due to the added stressors, some psychiatric medications that affect digestion, and anxiety triggers due to enclosed space with crowding. 

What can one do?

1) Talk to your provider if you are uncertain of the impact of air travel with your current conditions. 

2) If on medications, have a plan to be consistent as to when to take them (carry medications on board).

3) Wash hands often and keep hands from your face.

4) Move frequently during air travel, which may help with GI issues and blood circulation.

5) Consider lower body compression garments to help with preventing clots.

6) Plan out diabetic management needs, particularly if crossing time zones.

7) Plan to arrive early and focus on relaxation techniques to lower stressors as you are able.

8) Stay hydrated with water while traveling and consider skipping alcohol and large amounts of caffeine.

Statistically, flying is a very safe and efficient way to travel if able, but with these considerations the experience can be made even safer and more comfortable.