With COPD Is There a Limited Number of Hours it is Healthy to Fly?

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Dear Coach

It might be necessary for me to travel from east coast to Hawaii. My question is: with COPD is there a limited number of hours it is healthy to fly?

Thank you,
Looking to fly

Dear Looking to fly

There is no one answer to your question and it really depends on the person. Technically, no number of hours flying are healthy for a COPD patient to fly; some tolerate it better than others. A lot of it depends on how much oxygen you require and what the altitude does to your breathing. Airline cabins are generally pressurized at either 6 or 8 K feet with the larger jets usually being 8K; Jets flying longer distances fly at much higher altitudes. To give you some perspective; Denver is at 5000 feet . In general 20% of patients with COPD require supplemental oxygen but in Denver because of the altitude it is closer to 50%.

So where does this leave you? First, I would talk with your doctor to determine if it is safe for you to fly and if you should use supplemental oxygen if you do not already. I generally don’t use oxygen at sea level but when I fly without oxygen my saturations drop into the low 80’s down to middle 70’s and that can be dangerous. Even with oxygen I rarely get my saturations above 90.

If you do get the ok to fly, I would recommend breaking up your trip into segments to allow you as much time as possible to recover after each leg and if you are using supplemental oxygen give you time to recharge your batteries a little bit. Make sure you have a pulse oximeter with you at all times and monitor your oxygen levels all through the flight. If your doctor advises that you should use oxygen during the flight, make sure you have the airline oxygen forms filled out and signed by you doctor (these are available at each airline’s website) and carry them with you at all times. Airlines require 150% battery capacity which means if your flight lasts 6 hours you need to have 9 hours of battery capacity. This allows for delayed flights and longer than expected layovers. Also, make sure you have your battery charger in your carry on and use your layover time to recharge your batteries as much as time allows. It is also a good idea to contact the airline prior to the flight to tell them you use oxygen as often they will arrange special seating so your oxygen hose doesn’t encumber other travelers in your aisle.

Some other tips that might help you are: Ask for wheel chair assistance at every airport you travel from and to; you may not feel you need it; trust me when I say you will appreciate having done it as it will allow you to get through security quicker and you won’t have any long walks to the gate. When checking in at a gate, tell the gate agent that you have COPD and require extra time to board. They will generally board you first and allow you some time to get comfortable and arrange your oxygen. Keep your inhalers (if you have them) easily available to you at all times. Hydrate yourself a couple hours prior to the flight by drink water but avoid drinking too much water during the flight and avoid drinking alcohol and caffeinated beverages. Make sure you use the restroom just prior to boarding the flight. If you find your oxygen saturations dropping during the flight immediately start pursed lip breathing; you could run your oxygen at a little higher setting but keep in mind that this will also decrease your battery capacity.

Hope this helps
The COPD Coach

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  • My doctor had me take a High Altitude Simulation Test (HAST). It was pretty simple. They test oxygen level while you breath a mixture of oxygen and something else (I don't recall what). They used arterial blood sample to set the base line of your oxygen.
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  • My pulmonologist tested me for flying by doing an arterial blood sample. The order from the doctor will state how many liters, and if oxygen is to be used just when you reach altitude. If you need it walking in the airport, the orders will state that. When you buy your ticket you'll have to indicate you will be using portable oxygen. I flew recently, and some of the airlines don't require the order from the physician.

    I bought an Evergo Mini that gives me two batteries. One is for 8 hours, the smaller is for 4 hours. Neither one recharges that quickly. If I take a long flight, I guess I'm going to have to buy another 8 hour battery just to make sure. My experience is that the airline wants me to board early because they require I sit next to a window, and away from the exit. I also have had some employees be very rude. Just smile, and don't take that airline again.
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  • There are five health risks when flying:
    1. Low oxygen. Can check ABG to see if need to increase oxygen or have oxygen for flight. Most concentrators are FAA compliant.
    2. Bad heart. If you have heart failure, may have difficulty at altitude, may need to talk to your CHF specialist before flying.
    3. Infection. Get your flu vaccine and maybe bring a paper mask too. Can't be too safe. Be sure to bring your inhalers on the plane and emergency medicines (antibiotics, steroids, etc if leaving the country).
    4. DVT. It is easy to get blood clots on long flights. If you have had the problem before, you may need blood thinner to fly. If not be sure to hydrate, pace the aisle and move those feet.
    5. Spontaneous pneumothorax (ie, pop a bleb). If you have had recent chest surgery, you may not be able to fly as your lung can deflate at altitude due to the tiny wholes made with surgery. If you have bad bullous emphysema, your lung may leak as well, but this is hard to predict. It rarely happens on planes, but if it does you will need immediate medical help. Your lung doctor can help predict your risk.
    Talk to your doctor about the above! Can't help you with flight delays, lost baggage or bad food! Happy trails!


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  • People with COPD should always check with the specific airline. Some airlines provide the oxygen and some require you to bring your own approved concentrator. Oxygen tanks and liquid oxygen are not allowed. Thanks for all the good tips
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