TRAVEL WITH A LUNG PROBLEM – Tess Compton-Price

1. Travelling with a
Lung problem
A wise choice?

2. Lack of planning on your part does not constistute urgent
attention on my part!

3. Where can I go on holiday?
Climate: many people with lung conditions prefer warm climates that have salty
air such as by the Mediterranean sea. Lower oxygen levels at higher altitudes,
such as in mountains, can make breathing difficulties worse.
Temperature: extremes of hot and cold weather can affect your feelings of
breathlessness and lead to a flare-up of your condition.
Terrain: whether your destination is flat or on a hill, it could affect your ability
to get around comfortably.
Transport availability: the types of transport available at your destination.
Whether you have any special needs, such as oxygen treatment or wheelchair
access.

4. Wanting to Fly?

5. • Air travel is now a common mode of
travel for millions, with a single UK
airline carrying over 33 million
passengers annually.
• It is estimated that over 1 billion
passengers travel ,by air, worldwide
each year and for the majority this is
without hazard.

7. • Air travel is incredibly safe. A recent
estimate is that medical incidents occur at
a rate of 12 per million passengers flown.
• When many can be considered at risk and
few suffer harm, there is a temptation to
ignore the potential problem of flying with
an existing health condition completely.
This would be unwise

8. • If you can walk 100 metres (109 yards) on
the level, breathing only room air, at a
steady pace and have no breathlessness
or need to stop?
…..Then you are not likely to be troubled
by the reduced pressure in an aircraft
cabin
• If you can’t achieve this then you may get
into serious trouble during the flight or
even just getting to the flight gate in the
airport.

10. • Think… How far am I going to have
to walk from check-in to the flight
gate?
• In some instances this distance
could be in excess of 1 ½ miles
• If that is not possible then you will
need to arrange assistance at the
airport, but in advance – it is not
routinely available on the day.

11. You’re now at the gate –
ready to board.
The next problem ! …..

12. • Air pressure in an aircraft cabin is lower than air
pressure at ground level.
• Being in an aircraft cabin is like being at 6000-
8000 feet up a mountain.
• At high altitudes blood oxygen levels fall in
everyone and some people may feel a little
breathless.
• In most people this has no health effect. But if
you already have low blood oxygen levels
because of your lung condition, then the extra dip
that happens while you are on the plane can
cause too much breathlessness, your heart to
race and can be just too stressful for you.

13. Blood Oxygen levels
• At ground level normal oxygen levels in our
atmosphere are at 21%
• In an air aircraft cabin that will fall by
approximately 6% giving us 15% available
oxygen to breathe
• This means that the blood oxygen level in a lung
healthy passenger can fall to between 85-91%
(Normally maintained between 95-99% on the
ground)
• What is your blood oxygen reading at ground
level?

14. Maintaining your blood
Oxygen level above 90% is
essential on a long haul
flight (>4hours) for you to
be able to arrive safely and
enjoy your holiday..

15. RISK FACTORS TO FLYING
• FEV1 < 50% predicted
• Hypercapnia (High CO2 levels in the blood)
• Hypoxia at ground level (Low O2 levels in the blood)
• Lung Cancer
• Restrictive disease (Parenchyma, chest wall or muscles)
• Requirement for a ventilator
• Co-exisiting -cerebrovascular or cardiac disease
• Discharge from Hospital within 6 weeks after an
exacerbation of long-term lung or cardiac disease

16. What to do with the SpO2 (blood oxygen) and FEV1
result?
• SpO2 >95% + FEV1 >50% predicted then no further
assessment required, in-flight O2 unnecessary
• SpO2 92 – 95% with no risk factors then no further
assessment required, in-flight O2 unnecessary
• SpO2 92 – 95% WITH risk factors – then a HCT (Hypoxic
Challenge Test) needs to be performed
• SpO2 <92% at rest then advise in-flight oxygen required
without further testing.
• # Those already on supplemental oxygen should double
their usual flow rate whilst the aircraft is at cruising altitude.
BUT this cannot exceed 4 Litres/min

17. The Hypoxic Challenge Test
• The patient breathes 15% oxygen for 20 minutes
to simulate cabin conditions at maximum cruising
altitude
• SpO2 is monitored constantly using an Oximeter
and should not be allowed to fall below 85%
• Any symptoms are noted
• Arterial blood gases may be performed at
baseline and during testing.

18. Holidaying abroad with Oxygen
• If you need oxygen to use throughout your holiday then YOU
will need to make arrangements for the oxygen to be
provided before you travel. Your home supplier will not be
able to provide oxygen for you.
• If you are staying in Europe then you can arrange oxygen
through the European Health Insurance card scheme. You
will need a valid EHIC and will have to use the authorised
company for the country you are travelling to
• Contact the British Lung Foundation
Helpline on 03000 030 555 or
enquiries@blf.org.uk
• MON-FRI 9am-5pm

19. Holiday tips..
• Plan in advance – If you leave things to
the last minutes, you could forget
something crucial. Ask about your fitness
to fly before you book your holiday!
• Think about how far you can walk, how
many stairs you can manage, access to
toilets and what transport you can use.

20. • Be realistic – places you liked in the
past may not be suitable now. Pick
something you and your carer can
cope with physically
• Shop around – different companies
have different policies for people
with lung conditions, so find the best
deal for you.

21. • Ask questions – travel firms are used
to dealing with special requirements.
They should be able to answer all
your queries and concerns.
• Insurance – You should arrange full
travel insurance before going away.
If you are accompanied by a friend or
family member, it is worth checking
that they are fully covered too.

23. Travelling with Medication
• You will need a letter from your GP confirming
that you need medication and you should keep a
list of all the medication on you.
• List the proper names, not the brand names, and
keep all medication in its original packaging.
• All medication must be carried in your hand
luggage.
Please note;
Any liquid medication that exceeds 100mls will need
a separate letter from your GP

24. Have Diabetes?
When travelling east, the day will be shortened and if more
than two hours are lost, it may be necessary to take fewer
units with intermediate or long-acting insulin. When travelling
west, the travel day will be extended and if this is more than 2
hours it may be necessary to supplement this with additional
injections of short-acting insulin or an increased dose of an
intermediate-acting insulin.
Type 2 diabetes is not a problem on diet, oral medication, nor
indeed on insulin as the endogenous insulin, which remains in
Type 2 diabetes will provide a suitable buffer and assist
control.

25. • You are going to need to move
about every hour or so and exercise your
legs legs. Sitting for too long can lead
• to blood clots in the legs – known
• as a DVT (deep vein thrombosis)
If this is going to be a problem to do-
then flight socks are essential

26. Notifying an airline about your condition
It is important to note that although Cabin Crew are trained to
render advanced first aid, they are not trained to administer
medication. In addition, most airlines will assist passengers to
reach the toilet accommodation on the aircraft but cannot
render more personal hygiene or nursing care.
The majority of in-flight emergencies occur in situations when
an individual's medical condition is unknown to the airline and
it is therefore essential that the passenger’s doctor sends
adequate details well in advance of the flight to the carrier.
Most airlines have medical advisors who provide advice and
“clear” passengers as fit to fly.

27. The key information that they require is:
• The nature of your condition and its severity/stability,
medication being taken, and any pertinent information about
mobility.
The clearance can be done by telephone or by formal
communication using the MEDIF form, available through
travel agents or from the internet, which allows the medical
information to be structured in a manner that can be
processed by the majority of airlines.
NB: The final decision whether or not to carry a passenger
is that of the airline, but the more information that is
provided in advance, the more likely it is that a
reasonable, evidence based decision can be made.

28. In Summary
• Most patients with airway disease CAN fly safely with appropriate
assistance.
• Be prepared, plan before you travel – last minute.com won’t be
your friend!!
• Be realistic -Think about your own limitations and what support
you will need
• Take all your medications in your hand luggage
• Give yourself time to reach your flight
• Shop around for comprehensive insurance and declare all your
medical conditions, not just your lung problem.
• Discuss your needs with your proposed Airline in advance

29. You should always remember
that, even with in-flight
oxygen, air travel cannot be
guaranteed to be uneventful.
Having the Fitness to fly test
reduces the risk of potential
problems experienced during
the flight – but it is no
guarantee that it will be trouble
free.

30. If you decide not to Fly .. Then;
• There are always a car, coach, train, ferry, Motor
home or even a cruise liner for you to consider as
other modes of transport to your holiday
destination!

31. Holidays in the UK
The National Accessible Scheme (NAS) allows tourism providers to promote the
facilities they offer to disabled guests and older visitors. It rates accommodation by
four mobility categories, plus an exceptional accolade:
Category one – suitable for people able to climb a flight of stairs that have extra
fittings to aid balance
Category two – suitable for someone who needs a wheelchair some of the time but
can manage a maximum of three steps
Category three – suitable for people who depend on a wheelchair but who can
transfer unaided from the wheelchair in a seated position
Category four – suitable for a person who depends on the use of a wheelchair in a
seated position but needs help from a carer or a mechanical hoist to transfer.
Access exceptional – meets the requirements of independent wheelchair users or
assisted wheelchair users and also fulfils more demanding requirements.
Each category has its own logo, which is displayed by accommodation providers
that have been assessed. Further information about NAS can be found on Tourism
for All’s website.

32. How do I get to my destination?

33. Coach
Several coach companies are working towards making their
coaches accessible for people with disabilities.
Many National Express coaches now feature kneeling suspension,
which makes boarding and alighting easier. Drivers and coach
station staff will load and unload your luggage to and from the
coach, if items weigh less than 20kg.
Most on-board toilet facilities are now level with the coach seating.
If you give notice of your requirements when booking, you can get
help with boarding and with folding wheelchairs.

35. Trains
If you are thinking of travelling by train, get the leaflet Rail travel
made easy, available from most staffed railway stations or online,
or call National Rail Enquiries on 08457 48 49 50. This tells
you the minimum level of service you can expect throughout
Britain’s rail network.
Different train companies have different policies regarding
people with disabilities, so plan your route in advance and find
out which companies’ trains you need. All companies offer
assistance to customers if pre-booked.
Visit the Disability Onboard website for details of train
companies’ passenger assistance service and how to book it. It
also gives train travel tips, including detailed information about
the layout and accessibility of every train station.

36. Ferries
If you plan to visit one of Britain’s islands or travel to or from
Northern Ireland, you may go by ferry.
Many ferry companies have lifts, toilets and wheelchair
facilities and some can supply wheelchairs at terminals. A few
have special cabins for disabled people or offer discounts.
Check before and when you book, especially if you need
oxygen. Don’t forget to ask for extra assistance from the crew
before you travel.

37. Camping and caravanning
If you’re planning to go camping or caravanning, check access
arrangements to sites. The Camping and Caravanning Club has
three stages of accessibility. These are:
No accessible facilities
Accessible to those who can move around a little but not
wheelchair accessible
Fully accessible including shower blocks and facilities.
A list of accessible campsites in the UK can be found on the Love
Camping website or call 0845 527 3362.
A list of companies that sell adapted motorhomes or that can make
adaptations to vehicles can be found on the Camping and
Caravanning Club website.

39. Holidaying in the UK with Oxygen
• Oxygen for travel in the UK is provided by
the NHS.
• You just to let your usual oxygen provider
know the details of your holiday (ideally 6
weeks in advance for peak season –
otherwise 2 weeks is OK), including the
dates you are going and returning and
where you plan to stay and they will
arrange everything for you.

40. Any Questions?

41. Useful contacts for planning your holiday
Tourism For All
A national registered charity providing
information about accommodation and tourism
services for older people and people with
disabilities
c/o Vitalise
Shap Road Industrial Estate
Shap Road
Kendal
Cumbria LA9 6NZ
0303 303 0146
www.tourismforall.org.uk

42. Suitable accommodation around the UK:
Visit England: www.visitengland.com/plan-your-visit/access-all#/
Visit Scotland: www.visitscotland.com/accommodation/accessible
Visit Wales: www.visitwales.com/explore/accessible-wales
Discover Northern Ireland: www.accessibleireland.com

43. Transport
P&O Ferries
08716 64 21 21
www.poferries.com
Brittany Ferries
0871 244 0744
www.brittany-ferries.co.uk
Channel Tunnel
Eurostar
08432 186 186
www.eurostar.com
Euro Tunnel
08705 35 35 35
www.eurotunnel.com
National Express
08717 818178
www.nationalexpress.com
National Rail Enquiries
08457 48 49 50
www.nationalrail.co.uk
Disability Onboard
A website offering details of passenger assistance on trains
www.disability-onboard.co.uk
Civil Aviation Authority (CAA)
Information for air travellers
www.caa.co.uk

44. The European Health Insurance card (EHIC)
www.gov.uk/european-health-insurance-card
www.nhs.uk/NHSEngland/Healthcareabroad/EHIC
GOV.UK
The latest travel advice by country, your rights at the airport
and getting help abroad
www.gov.uk/browse/abroad/travel-abroad