Monthly Topic of Interest
Air Travel and A1AD
May 2008
(Please note: Whether planning a trip by air, train or automobile, your preparation and planning prior to the trip to allow for your supplementary oxygen use is of the utmost importance. Each mode of travel may present unique challenges and situations therefore it is necessary to check and double check plans and information.)
There are special considerations individuals with Alpha-1 lung disease need to bear in mind when traveling by air. Commercial airline cabins are not pressurized to atmosphere at sea level, but to a much higher altitude of approximately 8,000 feet. What this means is there is a lower concentration of oxygen in the ambient air during the flight. This is generally not a problem for individuals who do not have lung disease. For people with compromised lung function, however, the lower concentration of oxygen in the plane can put them at risk for developing hypoxemia.
If you require supplemental oxygen only during exercise or sleep, you may find that you require it for air travel and for being at a high altitude. Your physician will be able to determine whether or not you will need to make any special arrangements for oxygen during your travels. You should consult with your health care provider well in advance of your planned departure so that if necessary, you will have sufficient time to make the arrangements for your oxygen supplies to be delivered where and when you will need them.
There is a common misconception that the oxygen in the overhead compartment of an airplane can be used if oxygen is required during the flight. This is not so. This oxygen is not used for supplementing the needs of passengers requiring oxygen therapy; rather, it is for emergency use on the aircraft if cabin pressure is lost.
FAA in-flight oxygen requirements prohibit individuals from using their own oxygen equipment with the exception of specially approved rechargeable concentrators (POCs). Your personal liquid or gas oxygen equipment is not allowed for in-flight use. The reason for this is the flight attendants have been trained on the system used by the airlines, and if a problem should occur with this equipment, they will know what to do. If a problem were to occur with a passenger’s own equipment, the airline personnel would not necessarily know how to work it or resolve a problem. Therefore, the airline provides (at additional cost) individual oxygen cylinders and equipment to passengers who need supplemental oxygen.
Before you purchase your airline ticket, be sure to alert the airline of your need for oxygen therapy and find out how much they will charge you for this service. Most airlines require two weeks advance notice to guarantee oxygen arrangements. Some airlines can make these arrangements with as little as 48 hours advance notice. It is advisable to make the arrangements as far in advance as possible and to reconfirm your arrangements as the travel date draws closer. The importance of thoroughly planning your trip cannot be over emphasized. For instance, what plans do you have for using supplementary oxygen if you have a three-hour layover during your trip or if for some reason you miss connections on one leg of your trip.
The cost for oxygen varies from airline to airline, and some specifically smaller commuter airplanes do not provide the service at all. The cost of this service generally ranges from $75 to $150 per flight segment.
Be aware the airline will provide oxygen cylinders and supplies for you to use during the in-flight time only. They will not supply oxygen for you to use while you are transferring between flights, or while you are going to ground transportation or the baggage claim areas. If you require continuous flow oxygen therapy, you will want to make arrangements with a service provider for your oxygen needs during each segment of your trip.
Air Travel with a Portable Oxygen Concentrator - The Federal Aviation Administration has recently approved the use of certain portable oxygen concentrators (POCs) for in-flight use. Contact your oxygen provider to determine if they can provide one and the terms of it’s use. Since there are several different types of POCs, individuals should request a demonstration of the models the provider carries. The POCs do differ in size, weight and function. Not all airlines permit their use, some airlines limit their use to certain types of aircraft, others prohibit their use on commuter planes and still others restrict their use to a particular type of POC. It is important therefore; to check with the airline prior to making your travel plans to discuss their particular policy regarding the use of POCs and carry a copy of their policy with you. You must always notify the airline in advance if you are planning to fly with your portable oxygen concentrator. Normally the POC is not counted as one of your carry-on bags, but you may want to confirm that information.
Prior to flying with a POC you must obtain a signed statement from your physician and it must be available during each flight on your trip.
This statement typically includes;
- Your ability to respond appropriately to alarms
- When oxygen use is necessary (all or a portion of the trip)
- Maximum flow rate under normal operating condition
Be sure to get to the airport early, as security will do a thorough check of your concentrator. Plan to bring enough fully charged batteries with you to power your POC for the duration of the flight plus extra batteries for unanticipated delays. Although you may be able to access an electrical outlet on-board the aircraft, there is no way to guarantee this. An adequate supply of batteries is the safest option. To conserve battery life you may consider plugging into an electrical source while you are waiting in the airport for your flight. Bringing an outlet adapter to allow you to share electricity with someone using a laptop could be very helpful.
If you consider using an in-flight AC power connection, be sure to check with the POCs manufacturer in advance of flying to know if you will need to remove the batteries prior to plugging into an aircraft outlet. Also, check that your AC power adaptor is the appropriate type for the electrical outlet on the aircraft, if the aircraft provides the electrical outlets!
During take off and touch down you can store your concentrator under the seat in front of you. It is not necessary to turn the POC off during take off and landing.
If planning a trip overseas, it is essential that you check with the airline regarding traveling with your POC. Many airlines will not permit their use on overseas flights. Additionally, because of the differences in electrical current, as an example the USA uses 110Volts with 60Hz and Europe uses 220Volts with 50Hz, your POC may overheat and shut down even if using an appropriate adaptor. Be sure to discuss this issue and other issues associated with overseas travel with your POCs manufacturer or supplier prior to use outside the USA.
Connecting flights - If your travel plans require you to take a connecting flight, request a wheelchair with an attendant to help get you to the next leg of your trip. Riding instead of walking will conserve your energy and reduce the stress of fighting your way through the airport. Some larger airports have motorized carts to shuttle you from gate to gate. Do not leave it to chance that one will be available when you need it — call the airport ahead of time and make arrangements to have transport either by an attendant with a wheelchair or motorized cart ready and waiting at the gate when you arrive.
It is a good idea, whenever possible, to travel with a companion who knows what your needs are and can assist you. A travel companion should be familiar with the oxygen system you use so they can offer any technical assistance you might need and help you change cylinders, open tanks, attach a new regulator and adjust the flow. It is advisable to bring extra tubing, cannulas, adaptive pieces, tank wrench, T-connectors, swivels and electric adaptors so that you are prepared for any potential situations. Keep all necessary items in your carry-on luggage so they are available to you and there is less chance of them getting lost.
Despite your advanced preparations, you may still experience some unexpected disruptions in your plans. Do not be discouraged if your instructions are not adhered to 100 percent of the time. Learn from these experiences and make the necessary adjustments in your plans for the next time you travel.
Other concerns about air travel - Another consideration with airline travel is the air quality in the cabin. Cabin air is relatively dry, which can predispose individuals to an increased risk of acquiring an upper respiratory infection. Also, the close seating arrangements can pose a risk for contracting a respiratory infection for susceptible individuals. There are some simple precautions to take to help reduce your risks
when flying:
- Drink plenty of water to stay well-hydrated
- Avoid coffee, tea, and alcohol, as they tend to dehydrate
- Ask to be reseated if you are near someone who is coughing, sneezing or appears to have a cold
- You may choose to wear a mask as a protective barrier to help reduce your exposure to airborne droplets
- As a contingency, have a filled prescription for antibiotics to use should you develop an infection while you are away from home