Air Travel Can Be Safe and Well Tolerated in Patients with Clinically Stable Pulmonary Hypertension

Abstract

Our aim was to determine what proportion of patients with pulmonary hypertension (PH) has undertaken air travel contrary to the general medical advice and to characterize these patients according to disease severity and medical treatment. In cooperation with Pulmonale Hypertonie e.V., the German patient organization, a questionnaire was distributed. In total, 430 of 720 questionnaires were returned completed. Of the 179 patients who travelled at least once by air, the distribution of New York Heart Association functional classes I/ II/ III/ IV was 2/ 77/ 74/ 8, respectively; 83 patients were receiving monotherapy; 58 patients were receiving a combination of two or more therapies; 57 patients were on long-term ambulatory oxygen treatment; and 29 patients used supplemental oxygen while travelling. Overall, 20 adverse events were reported, mostly of mild to moderate severity (i.e., peripheral edema, dyspnea), with need of medical intervention in only 7 cases. The 251 patients who did not travel by air were, on average, in more advanced stages of disease and/or clinically unstable. In conclusion, a majority of patients (159 out of 179) did not experience any complications during or directly after the flight even though no special precautions were taken. Thus we conclude that for patients with PH in a stable clinical condition, air travel can be safe and well tolerated.

My life with pulmonary arterial hypertension: a patient perspective

“…We have found that patients are often concerned about their ability to travel with PAH, particularly at high altitudes, or to countries with a different climate. There are currently no data from randomized controlled trials regarding high-altitude safety for patients with PAH; although current guidelines recommend that patients bring extra oxygen for air travel, particularly if they are in World Health Organization functional class III or IV 17 , 28 . Patients should be counselled that they will need to ensure that they have enough medication supplies for their trip, and require facilities to keep medication on ice during the journey.…”

Diagnostics, monitoring and outpatient care in children with suspected pulmonary hypertension/paediatric pulmonary hypertensive vascular disease. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK

“…For patients with advanced disease, systemic pulmonary artery pressures and/or impaired ventricular function, it appears reasonable to use supplemental oxygen during the flight to minimise hypoxic vasoconstriction. The ESC and European Respiratory Society guidelines for PH recommend in-flight supplemental oxygen for patients with PH in FC III or IV and those with arterial partial oxygen pressure consistently <8 kPa (60 mm Hg) 42 55…”

Effect of hypoxia and hyperoxia on exercise performance in healthy individuals and in patients with pulmonary hypertension: a systematic review

“…Exposure to hypobaric hypoxia at altitude or during air flights increases PAP through hypoxic pulmonary vasoconstriction already in healthy individuals and, presumably, even more in patients with PH due to their impaired hemodynamics and gas exchange (10,34,67). According to questionnaire assessments on flight experience, the percentage of PH patients perceiving symptoms during exposure to a moderately hypoxic environment like commercial air travel (with minimal cabin pressure equivalent to 2,437 m) is mostly small (64). Thus among 179 air passengers with stable PH, 46% of these were in New York Heart Association class II or IV, 3% reported dyspnea, 3% peripheral edema, 2% exhaustion, 1% each heart palpitations, chest pain, headache, worsening of condition, or fear of flying, and a total of 4% required a medical intervention; only 2% of the patients used supplemental oxygen during flights.…”