By Phyllis Hanlon, contributing writer
According to the Bureau of Transportation Statistics, 64.4 million passengers boarded airplanes in January 2015. That was the highest number since June 2009 and the fourth highest of all time. The number of passengers continues to increase every year as people travel for a number of reasons — from business trips to vacations to family events. For those without serious health issues, flying is relatively safe. However, people with chronic heart or respiratory conditions should be aware of certain risks and exercise caution when air travel is needed.

To find out more about the factors that might impact air travel for passengers with cardiovascular issues, researchers from the Emory School of Medicine published a study earlier this year.

Laurence Sperling, MD, FACC, director of the Emory Heart Disease Prevention Center, led a team that looked at what happens to people on an airplane during flight. Today’s aircrafts are engineered to handle any sudden changes in air pressure to protect passengers. Despite these engineering advances, atmospheric pressure still drops at the high-flying altitudes. This usually poses no problem in healthy individuals whose bodies compensate for this by increasing the amount of air they inhale with each breath (tidal volume) and their heart rate. Additionally, every airplane is required to have several pieces of medical equipment on board, including a blood pressure cuff, resuscitation device, CPR mask, automated external defibrillator (AED) and some medications, such as antihistamines, aspirin, epinephrine, a bronchodilator and others.

Despite this, there are unforeseen situations that might have a negative impact on passengers with heart and respiratory problems or those who have had recent surgeries. Those with heart disease, particularly if coupled with lung disease, might experience a drop in oxygen levels. The authors reported that this would result in an elevated heart rate, an increase in blood and pulmonary artery pressure that could affect heart functioning. Furthermore, passengers with chest tubes, urinary catheters or tracheostomy tubes could be encounter problems. Other factors, such as anxiety related to fear of flying or sitting for too long, can produce changes in heart rate, blood flow and respiration.

Air travel is a bigger risk for passengers with pulmonary arterial hypertension (PAH). The authors cited studies that showed an increase in pulmonary artery pressure in PAH patients following flights of varying times and distances. One of the studies showed a 20 percent increase in pulmonary artery pressure after a nine-hour flight and nearly 10 percent increase 12 hours after landing. Even shorter flights can cause oxygen levels to drop. “Flight duration and resting use of supplemental oxygen were the two most important factors to predict significant desaturation during air travel,” the authors wrote.

Air used to control cabin pressures is very low in humidity. Scientists have observed that this can cause people to increase the amount of fluids they drink, which is another concern for PAH patients. The authors recommended being aware of how much fluid PAH patients drink and to avoid dehydrating drinks including alcohol, coffee and certain soft drinks.

The degree of the condition does have some bearing on the potential risks, the authors reported. They noted that PAH patients with New York Heart Association (NYHA) functional class I or II may not need additional oxygen when traveling by air; but those with NYHA functional class III or IV should receive inflight oxygen therapy. It is important for every PAH patient, regardless of their current functional class, to talk with their doctor to see if they should use supplemental oxygen before flying.

Air travel is also a risk for patients with predisposing factors for venous thromboembolism, a blood clot that starts in a vein, and is related to blood clots forming in a deep vein usually in the leg and pulmonary embolism when a clot travels to the lungs.

The authors of this study pointed out that the Federal Aviation Administration (FAA) requires that at least one flight attendant have training in advanced cardiac life support; and oxygen should be available. When a passenger knows they might need oxygen, they need to obtain a letter from their doctor at least 48 hours before the flight to ensure that they will have access to the therapy.

Since multiple blood flow changes take place in a person with PAH when traveling by air, the authors recommend consulting with a physician and careful assessment of the patient before boarding the plane.

Each PH patient is different. It is essential that you talk to your own doctor about what treatment options are best for you. For more information on finding a doctor or an accredited care center, visit

Additional PHA Resources on This Topic:

Ask a PH Specialist: As a PH Patient, What Can I Do to Make Traveling Easier for Myself?

Template Letters: Traveling Requests for Flying With medical Equipment, Permission to Fly With Oxygen and Permission to Cancel Flight