Can an elderly person with COPD advised to board a flight?

Question

Hello doctor,

This is regarding my father, 77 years old, who is a patient with COPD. He has been an ex-smoker for almost 40 years and has been suffering from shortness of breath for the last few years, but his situation got worse in the last year. He was prescribed a home Oxygen machine for at least 10 to 12 hours, nebulization on a daily basis and a few other medicines. He used to have swelling in his body and difficulty urinating. Doctors prescribed him diuretic medicine. A few months back, I took him to the emergency and spent a night over there, and later transferred him to the ICU (intensive care unit) for almost a week. His situation got worse, and doctors put him on a ventilator for 72 hours. He came okay and spent a few more days in the ICU, then transferred to a private room, spent a week in the hospital and was discharged.

At home, his situation was on and off and not actually improving. Now he was on a 24/7 oxygen machine and occasionally on BIPAP (bilevel positive airway pressure) too, used to do suctions on suction machines under the supervision of a male nurse provided to him for 24/7, nebulization thrice a day, but the situation was not improving much. A week ago, he was found unconscious and rushed to the emergency department. Again, put him on a ventilator for 48 hours and improving at a slower pace.

Being a daughter, I want the very best for my father and want advanced COPD treatment, available only in a few countries, called ’endoscopic lung volume reduction' treatment by introducing a small valve with minimally invasive surgery (within 20 to 30 minutes). I need your advice on this matter. I have uploaded the medical history report and the tests we have done here.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

Thanks for writing your query to me. I understand your concern about your father. I have reviewed all the reports attached (attachment removed to protect patient identity). Considering his current condition, your concern about air travel is important to address before booking tickets. It is not as simple as it may seem, but with careful evaluation and guidance, he may be able to fly on shorter destination flights.

It is crucial to remember that he is still recovering from severe respiratory failure and a cardiac event. Additionally, he remains oxygen-dependent at room temperature. Given his hypertension and recent hospitalization, it is advisable to avoid any travel for at least six weeks to prevent further complications. Fitness to fly for COPD patients requires meeting specific pre-travel eligibility criteria and obtaining necessary documentation from the treating pulmonologist.

During air travel on commercial flights, oxygen levels can drop significantly due to low cabin air pressure, so supplemental oxygen may be necessary to prevent further hypoxemia and other complications. It is advisable to check oxygen saturation frequently. If resting oxygen saturation is less than 92 percent, supplemental oxygen may be required in-flight. Commercial flights generally do not allow personal oxygen cylinders, but you can carry an oxygen concentrator with prior confirmation from the airline. The airline can provide supplemental oxygen if needed during the flight, but this service is usually costly and must be arranged well in advance when booking tickets. It is essential to consult his treating pulmonologist and conduct a pre-flight evaluation to determine if he is fit to fly.

Ensure all necessary medications, inhalers, and tablets are refilled before flying. If he is deemed fit to fly, consider booking a seat near the toilet to minimize walking, frequently check oxygen saturation, and avoid tea, coffee, or other drinks during air travel. Make sure to confirm all arrangements with the airline before booking tickets. Do not forget to obtain a fitness certificate and medical prescriptions from his doctor and carry them during air travel.

I hope this has helped you. Please feel free to reach me again, in case of further queries.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

Endobronchial valve replacement therapy is a non-surgical option for patients with advanced COPD. It improves exercise tolerance, lung function, and quality of life. It also increases the 5-year survival rate from 40 to 60 percent. However, it is available at only a few centers, and an expert team is required to carry out the procedure. The process of bronchoscopic lung volume reduction therapy with endobronchial valve replacement is straightforward, with no major complications. Approximately only 1 out of 10 patients with advanced emphysema are eligible for valve treatment, as not all patients meet the eligibility criteria. Therefore, it is very important to discuss the case well in advance with the doctor performing the valve replacement, as they are the best judge to decide if valve replacement is possible or not.

As discussed earlier, your father’s general condition is very critical at present. It is advisable to continue with oxygen support and neutralization treatment for now. Once he can wean off oxygen and his symptoms have improved, you can discuss further treatment with the concerned center. They will carry out the necessary investigations and decide on the next steps.

I hope you are satisfied with my answer. For further queries, you can consult me at icliniq.

Thank you.