The following recommendations are derived from literature reviews and aim to provide practical advice for respiratory physicians.
There is currently insufficient evidence to produce formal guidelines. To meet the need for consistent, practical, and comprehensive advice, the British Thoracic Society (BTS) Standards of Care Committee set up a Working Party to formulate national recommendations for managing patients with lung disease planning air travel. In particular, there is disparity between European and North American guidelines, uncertainty about assessment methods, and failure to consider other respiratory causes of hypoxaemia such as pulmonary fibrosis. 13 However, these references may not always be readily accessible to physicians and do not all provide consistent, practical, or comprehensive coverage. 3 Sources of available information include British and European, 4– 6 North American, 7 and Canadian 8 COPD guidelines, aviation medicine textbooks, 9 supplements to the journal Aviation, Space & Environmental Medicine 10– 12 and other publications on air travel. A recent national survey of respiratory physicians indicated that many would welcome advice. For potential passengers with lung disease it would clearly be valuable for their physician to have recommendations for assessing the fitness of their patients for flying. The aircraft crew are subject to regular medical examination but passengers are not. Nevertheless, greater awareness of the risks of air travel will enable physicians to encourage patients to fly safely wherever possible and increase the safety of fellow air passengers. One million residents of Denver, Colorado live at 5280 ft (1609 m) and coaches crossing high Alpine passes reach 10 000 ft (3048 m), indicating that moderate hypoxaemia is not generally hazardous. 2 Physicians should therefore be aware of the potential effects of the flight environment in passengers with lung disease. However, a North American service offering expert assistance by radio link for in-flight medical emergencies logged 8500 calls in 2000, of which 11% were respiratory in nature. There are still no established methods for quantifying the risk of in-flight medical problems.
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