2. Bronchial asthma and air
travelling
Ahmad Ali Abu-Naglah
Prof of chest diseases
Al Azhar university
3. Magnitude of problem
• 10.2% of in-flight medical emergencies calls
were respiratory in nature.
Cottrel J.JAMA 1989; 262(12):1653-6
. 17% of respiratory in flight emergencies
resulted in diversion of air craft and was 3rd
most common cause.
Sirven JI. Neurology,2002;58:1739-44
5. Problems associated with Air Travel
Over 1 billion people air travel each year world
over.
Passengers traveling by air are exposed to
following risks:
• Exposure to high altitude
• Risk of DVT
• Spread of Infectious diseases
8. Effects of altitude on Oxygenation
• At altitude of 8000 ft, partial pressure of
oxygen falls to a level, equivalent to breathing
oxygen at FiO2 of 15.1%
• In a healthy individual PaO2 falls to 53-64 mm
Hg and SpO2 falls to 85-91%
9. Different asthmatics
• Asthma symptoms vary greatly, from mild and
infrequent to debilitating and severe. The
extent of symptoms may influence the type of
trip
10. • Planning ahead is important and the traveller
should have their asthma as well controlled as
possible before departure.
• Many asthma sufferers find that their
condition improves on holiday but for others it
may deteriorate.
• This may be due to climate change, absence of
allergic triggers, stress or exercise/exertion
11. Air Travel
• Travellers who have well controlled asthma
and are fit and well should have no problems
with air travel.
• Those with severe asthma may have
difficulties due to reduced air pressure within
the cabin.
13. Who should be evaluated ?
• Severe COPD or asthma
• Severe restrictive disease, especially with hypoxemia
• Cystic fibrosis
• Recent Pneumothorax
• Pre-existing requirement for oxygen or ventilator support
• History of air travel intolerance with respiratory symptoms (dyspnea,
chest pain, confusion or syncope)
• Risk of or previous venous thromboembolism
• Conditions worsened by hypoxemia (cerebro vascular disease,
• coronary artery disease, heart failure)
• Cases of Tuberculosis
BTS 2004 recommendations
14. Preflight evaluation
• History & examination
• Spirometry
• SpO2
• ABG
• Regression estimates of
PaO2
• Hypoxia Inhalation Test
• 6 minute walk test
15. • As a guide, if someone can walk for 50 meters
at a steady pace without feeling breathless or
needing to stop they should be able to cope
with the reduced cabin pressure.
• If they cannot do this then medical advice
must be sought before travel.
16. • Most people with asthma do not require to
take their medication via a nebuliser.
• A standard metered dose inhaler and large
volume spacer device is usually an equally
effective alternative
17. Altitude
• People who are unaccustomed to living at
high altitude may become unwell with acute
mountain sickness even if they are fit and well
prior to travel.
• However if asthma is well controlled, once
acclimatised most people should be able to
cope at high altitude.
18. Cold and exercise
• People whose asthma is triggered by cold may
find the drop in air temperature a problem
and those who have exercise-induced asthma
could be affected by the exertion of climbing.
19. • The limited data available suggests that
asthma is not exacerbated by high altitude if
adequate preparation and caution is advised
20. House dust mites
• If house-dust mite is a trigger factor for some,
they may find that their asthma improves at
high altitude as dust mite cannot survive at
this height.
21. • It may be necessary to increase inhaled
steroids for a few weeks prior to departure
and to monitor peak flow measurements
whilst away
22. Aerosol metered dose inhalers
• Aerosol metered dose inhalers may not
function properly under freezing conditions
and may need to be warmed in the hands
before use
23. Effect of ozone
• Ozone can be problematic for some people,
levels are higher on hot summer days and if
this is a trigger factor avoid exercising outside
in the afternoon
24. Advice for patients traveling to high
altitude
• Staying at low altitude has a significant
beneficial effect for asthmatic patients, due to
the reduction of airway inflammation and the
lower response to bronchoconstrictor stimuli.
• For staying at moderate altitude, there is
conflicting information and no clinical data
25. • At high altitude, the environment seems
beneficial for well-controlled asthmatics, but
intense exercise and upper airway infections
(frequent during trekking) can be additional
risks and should be avoided.
• Further, in remote areas health facilities are
often difficult to reach.
