Airplane travel can be safe, manageable for PH patients: Study
Some may need oxygen support during flight to help with breathing
Airplane travel appears to be safe for people with pulmonary hypertension (PH) with both slight and marked limitations of physical activity, though some individuals may need oxygen support on board to help with breathing, according to a new study.
While some patients in the study, dubbed PEGASUS (NCT03051763), experienced mild discomfort during or after their flights, nearly all who flew were willing to do so again, suggesting air travel can be manageable with proper precautions.
“Our study gives evidence that air travel is safe in patients with PH,” the researchers wrote, noting that “no severe adverse events occurred during and after … flight.”
The study, “Air travel in patients suffering from pulmonary hypertension — A prospective, multicentre study,” was published as a research letter in the journal Pulmonary Circulation by scientists in Germany and Switzerland.
The researchers did note that further investigation is needed given this study’s small size and the short duration of the flights taken.
No clear guidelines available for airplane travel with PH
Traveling by air can put a strain on the heart and lungs because less oxygen is available to the body’s tissues at high altitudes. This causes blood vessels in the lungs to narrow, which increases pressure within them, making the right side of the heart work harder to circulate blood.
As treatment options for PH have improved, patients are living longer and better lives, the researchers noted. As a result, more people with PH want to travel, including flying by commercial airplane. However, it’s not clear if air travel is safe for them or which precautions they should take.
“Current guidelines for PH do not give clear recommendations regarding air traveling, apart from the advice of oxygen therapy and dependence of the functional class,” the researchers wrote. PH is divided into four classes based on severity, with the functional classification used to rate how sick patients are.
Here, the PEGASUS study aimed to see if air travel is safe for adults with PH who had decided to travel after planning and discussing it with their doctors. The patients filled out questionnaires at different times, including before and after their flights.
Of a total of 239 patients, 72 traveled by air during the study period. However, 12 were excluded because their data were incomplete, leaving 60 patients in the flight group. Most of these patients (75%) were female, with a median age of 57. The most common PH subgroup was pulmonary arterial hypertension.
Almost two-thirds (65%) of patients were in World Health Organization functional class II or class III. Class II means these individuals have no symptoms at rest but experience discomfort and shortness of breath during normal activities, while class III indicates these patients experience marked limitations during normal chores.
Less discomfort seen for those using oxygen therapy during flight
The median flight time was three hours. During and after the flights, the patients were monitored for symptoms, pulse, and oxygen saturation — a measure of the amount of oxygen that’s circulating in the blood. Median oxygen saturation at the start of the flight was 95%.
During the flight, 14 passengers (25%) needed supplemental oxygen. Patients who didn’t receive oxygen therapy had significantly lower oxygen saturation during the flight compared with those who did (89% vs. 92%), and were more likely to report discomfort. Those with desaturation, meaning a minimal oxygen saturation during flight not superior to 85%, were more likely to show symptoms during their flight.
Nine patients (13%) self-reported symptoms — including pressure in the chest, dizziness, shortness of breath, and palpitations — during their flights, with most occurring within one hour of takeoff.
After landing, 12 individuals (20%) reported a worsening of symptoms, mostly within 30 minutes of landing. One (2%) experienced tachycardia, or an abnormally rapid heart rate, which required medical attention and treatment.
Oxygen supplementation during flight was well perceived by [patients] and helped to reduce reported symptoms.
The study also looked into why some patients chose not to fly. More than half (58%) said they simply had no travel plans, while others cited anxiety (17%) or their doctor’s advice (13%). However, nearly half (44%) of those who didn’t fly were still interested in air travel, and nearly all who did fly said they’d do it again.
Given the small overall number of patients involved, the researchers noted that “further and more extensive prospective studies are warranted to enhance the generalizability of our findings.”
Moreover, while patients experienced only mild discomfort during or after their flights, “air travel was short, thus, we cannot draw conclusions on PH patients with high risk profile and longer flights,” the researchers wrote.
The team also noted that “oxygen supplementation during flight was well perceived by [patients] and helped to reduce reported symptoms.”
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