Air Travel Safety for Patients with Pulmonary Fibrosis

Pre-Flight Assessment

Patients with pulmonary fibrosis should undergo pre-flight assessment to determine if supplemental oxygen is needed during air travel, as the reduced cabin pressure can cause significant hypoxemia and respiratory distress, according to the British Thoracic Society 1, 2
The American Thoracic Society recommends that patients with pulmonary fibrosis be assessed before flying, as they fall under the category of "severe restrictive disease" 1, 3
Assessment should include medical history and examination focusing on cardiorespiratory symptoms and previous flying experience, as well as spirometry testing, as suggested by the European Respiratory Society 3, 4
Measurement of oxygen saturation (SpO₂) by pulse oximetry at rest is also recommended by the American College of Chest Physicians 3, 5

If sea level SpO₂ >95%, oxygen is not required during flight, according to the British Thoracic Society 2, 6
If sea level SpO₂ 92-95% with no additional risk factors, oxygen is not required, as recommended by the American Thoracic Society 2, 6
If sea level SpO₂ 92-95% with additional risk factors, a hypoxic challenge test should be performed, as suggested by the European Respiratory Society 2, 6
If sea level SpO₂ <92%, in-flight oxygen is recommended without further testing, according to the American College of Chest Physicians 2, 6

Patients with pulmonary fibrosis should avoid excess alcohol before and during the flight, remain mobile during the flight if not receiving oxygen, and be aware that exercise without supplemental oxygen may worsen hypoxemia, as recommended by the British Thoracic Society 3, 7
Patients should take preventive measures against venous thromboembolism, especially for long flights, and carry all medications in hand luggage, as suggested by the American Thoracic Society 3, 7
Patients requiring in-flight oxygen should disclose oxygen needs when booking with the airline and consider oxygen needs on the ground and during flight connections, according to the European Respiratory Society 2, 6
In-flight oxygen is typically prescribed at 2 L/min via nasal cannulae, as recommended by the American College of Chest Physicians 5, 9

Special arrangements must be made with airline and airport authorities for oxygen-dependent patients, and patients should carry all usual medications, a copy of medical forms, and travel with a companion, as suggested by the British Thoracic Society 6
Oxygen-dependent patients should choose direct flights when possible and ensure oxygen availability throughout the entire stay at destination, according to the American Thoracic Society 6