Dr Robina Coker, chair (left), and Professor Martyn Partridge, member, BTS Air Travel Working Party

The British Thoracic Society (BTS) recently published recommendations for managing patients with respiratory disease planning air travel.1

More than one billion people are estimated to travel by air each year. Although the vast majority travel safely on commercial flights, an increasing proportion are at risk of respiratory complications triggered by hypoxaemia, immobility and dehydration.

Although there is currently no method for quantifying the risk, the BTS recommends that patients with severe obstructive or restrictive lung disease, including asthma, COPD, cystic fibrosis, pulmonary fibrosis, neuromuscular disease and kyphoscoliosis, should be assessed before flying.

Preliminary assessment should include a history, examination and record of previous flying experience. Spirometry and oximetry should be performed.

Hypoxic patients require further evaluation, which may include a walk test and/or hypoxic challenge test, carried out in a specialist lung function unit.

The BTS recommendations are primarily aimed at hospital-based lung specialists. A summary document for GPs is available on the Thorax website: www.thoraxjnl.com and on the BTS website: www.brit-thoracic.org.uk.

In most circumstances GPs should follow normal clinical practice and refer those patients they consider to be at risk from flying to a specialist. This is particularly important where more complex investigations such as a hypoxic challenge test need to be performed.

Many patients, for instance those with severe COPD, will already have been referred for specialist advice on more routine aspects of their clinical management. However, as spirometry and pulse oximetry are now available in some practices, some GPs may wish to perform a preliminary assessment themselves.

If pulse oximetry reveals patients have an SpO2 >95% on air they should be able to fly safely without supplementary oxygen. Patients with SpO2 values lying between 92 and 95% but who are otherwise well and whose FEV1 is >50% predicted should also be able to fly safely.

Other patients will require further evaluation by a hospital specialist.

Hypoxic challenge testing can only be conducted by a specialist lung function unit and is usually performed only at the request of a hospital specialist.

Patients at risk of venous thromboembolism should be given advice according to the GP summary, which follows the House of Lords Select Committee on Science and Technology report.2

More research is needed in this field. However, the BTS document gives the best available up to date guidance to help lung specialists choose the most appropriate test for each individual.

As air travel becomes more common, the safety of patients with lung disease becomes a bigger issue. Lung specialists are aware of this, and will work with GPs to provide these tests as part of NHS care to enhance the health and safety of all those with lung disease who travel by air.


  1. Managing passengers with respiratory disease planning air travel: British Thoracic Society recommendations. Thorax 2002; 57: 289-304.
  2. House of Lords Select Committee on Science and Technology. Deep vein thrombosis, seating and stress. In: Air Travel and Health. Report of House of Lords Select Committee on Science and Technology 2002: 44-50.

Guidelines in Practice, August 2002, Volume 5(8)
© 2002 MGP Ltd
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