Safe to Travel? | COPD Foundation

This article was reviewed by Senior Director of Community Engagement and COPD360social Community Manager, Bill Clark, as well as certified staff Respiratory Therapists on January 23, 2020.

Dear COPD Coach,
I have COPD but do not yet require supplemental oxygen. I am planning to fly to visit my son. The flight is scheduled to be two legs, one lasting 1 hour and the other two hours. Is it safe for me to fly even though I do not use oxygen?

-Ready to Travel

Dear Ready,
Your question is a very good one! Like most of the questions we get, the answer is not simple, and the short answer is a definite “maybe.” I’ll explain.

In all commercial air travel, the planes are pressurized. How much they are pressurized depends on the size of the plane and the altitude it at which it flies. Most large planes flying above 30,000 feet would be pressurized to an altitude of up to 8,000 feet. To give you some perspective, the altitude of Denver is 5,300 feet and has about 17% less oxygen than cities at sea level. The smaller regional jets generally fly around 20,000 feet and thus usually are only pressurized to around 6,000 feet.

At any pressurization, people with normal lung functions will usually measure a drop in their oxygen saturations, especially on long flights. On the other hand, someone with compromised lungs will usually experience a substantial drop in their saturations. For a person with normal lung function, the worse they will suffer is sleepiness but usually recover their saturations very quickly afterthey land. A person with breathing difficulties will most often experience head and muscle aches, saturations below 90 and require a significant time to recover their oxygen saturations once they land.

There is a test that has been developed to simulate the oxygen content of the air at high altitudes and monitor the person’s response to the change in conditions. The test is called High Altitude Simulation Testing (HAST) or the Hypoxic Challenge Test (HCT). There are a variety of methods to create this simulation, but basically, a person would be instructed to breathe through a mask that is being supplied with 15% oxygen, which is about what is available in the cabin during a flight. During the test, the person is continuously monitored with a pulse oximeter. If the person’s oxygen levels drop below a certain point determined by the doctor, the oxygen is increased until the oxygen levels are in a safe range. This test, while not available in all areas, provides a measure of confidence both for the traveler and their healthcare team.

If the HAST is not readily available in your area to determine how you will fare in flight, it will require a guess on the part of your pulmonologist. A test has been developed using a formula using an algorithm based on a study of 100 COPD patients with moderate to severe COPD. While the results tend to over-estimate the number of patients requiring in-flight oxygen, they are considered a safe “estimate” as to who can safely fly.

Here is how the algorithm works:

If the patient has resting saturations of less than 92% they require supplemental oxygen in-flight. If a patient’s 6-minute walk test results drop to an O2 Sat (oxygen saturation) in the low 80% range, that person will require supplemental oxygen.

Ultimately, it is up to your pulmonologist to determine if it is safe for you to fly. You can use supplemental oxygen on a commercial flight only with a doctor’s prescription. Furthermore, if you do not qualify based on the results of the algorithm, it does not mean that you will not experience ill effects from flying, especially on long duration flights. Feel free to share this information with your respiratory health care professional and ask about following this guideline.

If you do not use supplemental oxygen to fly, you can do the following to help make the trip more pleasant:

  • Take your pulse oximeter with you, and measure your saturations frequently during flight.
  • If your saturations begin to drop below 90, begin pursed lips breathing.
  • Stay relaxed during the flight, and don’t be in a hurry to deplane.
  • Avoid alcohol and caffeine prior to, and during, the flight.
  • If your saturations drop into the 80% range, notify your doctor.

Visit our Traveling with COPD page to learn more.

Good luck and have a nice flight!

-The COPD Coach

Coaches Corner is aimed at providing information for individuals with COPD to take to your doctor, and is not in any way intended to be medical advice. If you would like to submit a question to the Coaches Corner email us at [email protected] We would love to hear your questions and comments. You can address your emails to The COPD Coach.


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