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Air Travel 

Introduction

Air travel can expose you to a number of factors that can impact your health and well-being.  Although most travellers won't notice any adverse effects to their health during a flight, the effects from flying may present challenges if you have certain underlying health conditions.

Airline restrictions on flying

The airline you plan to fly with needs to make sure it is medically safe for you to fly, so you might need to tell them about any health condition you have.  Airlines might not let you travel with them:

  • if they are concerned that you have a medical condition that might get worse during a flight
  • if you have an illness that could infect other passengers

Restrictions and rules can vary between airlines, so if you are in any doubt, you should seek advice from the medical department of the airline. Most airlines have a medical advisory service, details of which can usually be found on their website.

If you think your health might be affected by flying, you should contact your GP or specialist before you book a flight.

Travel by air is not normally advised in the following cases (this list is not exhaustive):

  • infants less than 48 hours old (longer after premature births)
  • women after the 36th week of pregnancy or 32nd week for multiple pregnancy
  • if you suffer from or have had:
    • angina or chest pain at rest
    • an infectious disease (e.g. chickenpox, flu), including COVID-19
    • decompression sickness after diving (sometimes called 'the bends')
    • increased pressure in the brain (due to bleeding, injury or infection)
    • infection of your ears or sinuses
    • recent heart attack
    • recent stroke
    • recent operation or injury where trapped air or gas may be present in the body (e.g. stomach ,bowel, eyes, face, brain)
    • severe long term diseases that affect your breathing
    • breathlessness at rest
    • unresolved pneumothorax (punctured lung)
    • sickle cell anaemia
    • unstable mental health or psychotic illness

Consideration of security measures 

Security restrictions on the type of equipment and fluids which can be taken into the aircraft cabin might affect what medical equipment or medication you can bring with you for use during a flight.

If you have been fitted with any metal devices such as an artificial joint, a pacemaker or internal automatic defibrillator, then you should:

  • carry a medical alert letter from your doctor
  • alert the security staff that you have a medical device fitted before passing through any screening equipment

Health considerations when flying

High Altitude

High altitude is generally considered to be 2,400 metres (8000 feet) and above. Aircraft cabins are kept at a pressure approximately equivalent to between 1,800 to 2,400 metres; developing symptoms due to high altitude (altitude sickness) is not usual during flights for most people. However, if you have a lung or heart condition, you might need to use oxygen during a flight because of the higher altitude.

If you fly in to an airport that is above 2,400 metres, for example in the Andes and Himalayas, you might get signs of altitude sickness. 

Using oxygen whilst flying

If you have a lung or heart (cardiac) condition, your symptoms might become worse during or after a flight, particularly if you become dehydrated or have over exerted yourself. You may need oxygen during the flight, even if you do not usually need it:

  • In advance of your flight you must arrange with the airline the use of oxygen and any assistance you need at the airport.
    • If you use your own home oxygen, you must still contact the airline in advance to discuss if you are able to use it on the flight.
  • You will need to contact your GP or specialist as they may need to provide medical information to the airline.

Pregnancy

If you are healthy and your pregnancy has been straightforward, then air travel is generally considered safe. However, some pregnant women with underlying risk factors might be at increased risk of complications such as deep vein thrombosis (DVT) from flying.

  • You should get advice from your midwife or obstetrician before booking any flights.

Airlines request a medical certificate from pregnant travellers if travelling after 28 weeks of pregnancy:

  • most airlines won't allow air travel after 36 weeks for a single pregnancy, and 32 weeks for multiple pregnancies
  • the medical certificate should detail your estimated delivery date and confirm that your pregnancy is uncomplicated and progressing normally

You must ensure you have travel insurance which covers both yourself and your unborn baby (in the event you need to give birth unexpectedly during your trip).

Flying with a disability

Navigating an airport and flying can at times be stressful, cause anxiety and be physically exhausting.  Many airports offer assistance services for those who have physical or hidden disabilities but these may need to be booked in advance.  Cabin crew are not allowed to assist passengers who are unable to look after their own physical needs (such as using the toilet, assistance with meals or mobility) during a flight.

  • It is important that you make the airline aware of any special requirements you may need during the flight as soon as possible.

You should contact your airline well in advance of travel to check what assistance might be available to you for:

  • your journey through your departure airport
  • boarding the aircraft and during the flight
  • disembarking the aircraft
  • transferring between flights
  • travelling through your destination airport

If you use an electric mobility aid such as an electric scooter or wheelchair, you will need to provide your airline with details of your equipment (such as make, model, size or weight) well in advance of your flight to enable the airline to check they can safely load and stow your equipment and undertake a fire risk of electrical equipment.

  • If you use a wheelchair and wish to remain in your own chair to the aircraft door rather than transfer to an airline wheelchair at check-in, you should inform your airline of your particular needs as soon as you can.
  • Showing airline crew your equipment’s operating manual may be helpful, especially if they have any issues loading, disassembling or reassembling your equipment into the aircraft hold.

Infectious Diseases

To reduce the potential risk of passing on infections to others on board an aircraft, you should postpone travel if you are actively unwell, especially if you have a fever, until you have fully recovered.

The quality of aircraft cabin air is carefully controlled and research has shown that there is a very low risk of infectious diseases being transmitted on board. The risk is no different from being sat close to someone on other forms of transport such as a bus or train. When transmission of infection does occur between passengers, usually as a result of a cough or sneeze or by touching surfaces which have been contaminated, they are usually seated in the same area of an aircraft.

An airline can deny boarding of any passenger who looks unwell, especially if they suspect the passenger might be infectious (infect other passengers). 

  • If you have recently recovered from an infectious disease, but are still showing physical signs of being unwell, for example crusted spots following chicken pox, then you should carry a letter from a GP confirming that you are no longer infectious.

If someone has already travelled and is then found to have a serious infectious illness (such as measles or COVID-19) which could be a potential risk to other passengers, then contact tracing of passengers will be carried out by local public health authorities.

Coronavirus (COVID-19)

You should not fly if you have experienced recent symptoms of COVID-19 or have been identified as being a close contact of someone who has experienced COVID-19.

You should check the latest UK advice on the length of time you must self-isolate for after symptoms develop or being identified as a close contact, before deciding on travel:

Further information on reducing your risk of exposure to coronavirus (COVID-19) during travel is available on the COVID-19: Health Considerations for Travel advice page.

Potential in-flight health problems

Dehydration

The circulating air inside aircraft cabins is very dry and can affect your skin, lips, nose and eyes. Discomfort can be reduced by using:

  • skin moisturisers
  • saline nasal sprays
  • lip balms.
  • glasses instead of contact lenses, which may cause irritation

Alcohol and caffeine containing drinks can make you pee more which can lead to dehydration:

  • you should try to drink plenty of clear fluids, such as water, during long flights and limit how much alcohol and caffeine you drink

Deep Vein Thrombosis (DVT)

The cramped conditions and long periods of being less active on a flight can cause pain, stiffness or swelling of your legs. Being less active can lead to slow blood flow in your veins which increases your risk of developing a blood clot, known as deep vein thrombosis (DVT). DVTs most commonly form in the legs. Part of the clot may break off and travel to the lungs, causing a pulmonary embolism (PE) which is potentially life threatening.

  • See the Deep Vein Thrombosis advice page for further information and advice on reducing your risk of DVT during travel.

Ear nose, throat and dental conditions

It is common to experience a 'popping' sensation in your ears during take-off and landing. This is caused by the air pressure changes that occur during a flight mean that during take-off air moves out of your middle ear and sinuses and during landing it flows back into your sinuses and middle ears.

 If you experience any discomfort, simple measures usually relieve symptoms such as:

  • swallowing
  • chewing
  • yawning
  • using a pacifier (dummy) in infants (as it mimics swallowing)

If you are suffering from an ear or sinus infection you may experience intense pain during take-off and landing.

  • You should discuss this with a doctor prior to flying as it may potentially cause an injury within your ear.

General dental treatment, such as dental fillings, are not usually a contraindication for flying. However, some dental conditions or treatment can result in pockets of trapped gas (for example, unfinished root canal treatment, dental decay or abscesses) which may cause pain and discomfort when flying. You should seek advice from your dentist before flying in this instance.

Flying after diving

Flying too soon after diving might lead to you developing complications such as decompression sickness (more commonly called “the bends”). The general rule is to avoid flying until 12 -24 hours after your last dive. If in any doubt, you should seek specialist advice from your diving school before flying.

Jet Lag

Jet lag is the term used for when your normal sleep pattern is disrupted due to crossing multiple time zones.

Jet lag can cause:

  • difficulty sleeping at night
  • wanting to sleep during the day
  • difficulties in concentration and remembering things
  • changes to your mood
  • changes to your appetite
  • nausea (feeling sick), indigestion and constipation

Effects of jet lag gradually wear off as your body adapts to the new time zone.

To minimise the effects of jet lag, you can consider the following measures:

  • Try to begin adjusting your body to the new time few days before travel by going to bed 1 to 2 hours later if travelling westward, or earlier if travelling eastward.
  • Change your sleep schedule to your new time zone as soon as possible after arrival.
  • If you take medication that needs to be taken at a specific time (for example antibiotics or insulin), you should speak to your GP or specialist to plan an altered schedule for taking your medication which takes time zone differences into consideration.
  • On long haul flights, you should:
    • stretch and walk in the cabin when you can
    • drink plenty of water
    • avoid excess alcohol or caffeine
    • try to sleep on the plane during an overnight flight
  • Once at your destination:
    • spend plenty of time outdoors in the natural daylight
    • try to eat meals and go to bed according to local times
  • If you are tired during the day, try taking a short nap (approximately 20-30 minutes) as this is unlikely to affect your ability to sleep at night.
  • Avoid heavy commitments on the first day after travelling:
    • be prepared for tiredness in the evenings and early waking, which can last up to 5 days or more

Motion sickness

It is uncommon to experience motion sickness during flying unless there is severe turbulence. If you are known to suffer from motion sickness in flight, you should:

  • choose a seat in the mid-section of the aircraft
  • keep motion sickness bags nearby
  • avoid alcohol during and for 24 hours before a flight
  • discuss with your GP medications to manage your symptoms if they can be severe

Fear of Flying

Fear of flying is a common phobia to have.  If you suffer from fear of flying, the following tips might be useful:

  • A visit to your doctor prior to travel can provide you with reassurance about your general fitness for air travel:
    • in severe cases, your doctor may be able to refer you for cognitive behavioural therapy in order to learn different ways to overcome your fears
  • Tell the cabin crew:
    • reassurance about routine aircraft sounds and inflight activities can help reassure you
  • On a flight, try distracting yourself by talking with other passengers, watching a film, listening to music or reading.

A number of airlines run courses aimed at alleviating fear of flying. Some of these are listed here:

Air Rage

This term is used to describe threatening behaviour or violence occurring on an aircraft, usually provoked or worsened by stress and frustration.  Airlines will, when necessary, divert aircraft to offload disruptive passengers and legal action taken against those involved.

Minimising the triggers causing air rage involves:

  • avoiding excess alcohol and substance misuse
  • remaining calm when dealing with stressful situation such as crowding, delays and lack of information
  • using nicotine gum or patches to avoid the agitation of nicotine withdrawal when smoking is not allowed in airport buildings and during the flight

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