Ask a PH Specialist
Question: As a Pulmonary Hypertension Patient, What Can I do to Make Traveling Easier for Myself?
Traveling can be a stressful time for anyone. However, travel for people with pulmonary hypertension may be especially stressful with extra planning needed before a trip. Issues to consider include medication, blood clots, emergency contact information, overexertion, need for oxygen and eating on the road. For many patients who use supplemental oxygen or who have borderline low oxygen levels, method of travel will play a major role.
Travel to higher altitudes may present a specific challenge due to lower oxygen levels in the air. When traveling on the road by car, train or bus at higher elevations, increased levels of supplemental oxygen may be necessary, especially when above 4,000 – 5,000 ft. Symptoms to look for include fatigue, more shortness of breath at rest or with activity, rapid breathing, lightheadedness, rapid heartbeats and headaches. On the road, the change in elevation may be gradual and not noticeable until you get out and move around. However, the change occurs rapidly if traveling by plane. Fortunately, passenger airplanes pump compressed air into their cabins when traveling above 10,000 ft. But oxygen levels are 25 percent lower in pressurized cabins compared to sea level. People who use oxygen only at night or one to two liters with activity typically do well without the need for oxygen during the flight. However, people who use two liters at rest or three to four liters with activity will likely need oxygen during air travel.
In some medical clinics, one can perform an “altitude test” using a special pressurized chamber to test oxygen levels at different altitudes to determine whether oxygen will be needed. The test, however, is not routinely needed prior to travel. Certain portable oxygen concentrators (POC) can be used in-flight but must be approved by the airline ahead of time. Empty oxygen tanks and POC can also be checked as luggage.
Recommendations for Traveling With Oxygen:
- Ask your doctor if you need oxygen while traveling. Ask for a “medical certificate” that states why you need oxygen (i.e., why it is medically necessary) and the “flow rate per minute” that you need (allowable range = 0.5-6 liters/minute). The certificate must also state the oxygen user is physically and cognitively able to use it and respond to warnings/alarms.
- When booking your ticket, let the airline know that you need oxygen in-flight.
- Federal law requires that oxygen be dispensed only by the airline. Each airline works with an oxygen provider. Charges vary. (American Airlines, for instance, charges $100 per segment for oxygen service. This fee may or may not be covered by insurance.)
- Contact the oxygen vendor at your final destination to arrange for oxygen once you arrive. This is done separately through a health agency and not through the airline.
- If using a POC, check with the airline to ensure it is approved. Bring enough batteries for 150 percent of the expected flight duration in case of delays.
Certain medications like epoprostenol (e.g., Flolan®) require pumps, cooled storage and extra supplies. Carry extra tubing, needles, backup pump and extra medication. Be prepared in case of delays by having extra medication packed in your carry-on luggage. If your medication requires being kept cool, bring six to eight ice packs and a premixed dose. Anticipate how you could handle flight delays or cancellations.
Long periods of inactivity during travel may raise the risk of developing a blood clot. With air travel, get up and be active. Consider support stockings for your legs if you have had a blood clot in the past. If traveling by ground, stop frequently (at least every two hours) and walk for a couple of minutes.
Eating on the Road
We eat differently when we travel. Be aware of eating foods that are high in salt as extra fluid will be retained. Try to eat lightly with lots of fruits and vegetables and limit the temptation to eat fast food (high in salt).
Talk to your doctor ahead of time and come up with a plan in case you develop symptoms such as swelling in the legs, worsening shortness of breath, fatigue or other symptoms. Get your medical certificate at the visit. Carry your PH center contact numbers with you. Ask your PH doctor who they would recommend you contact in the area you are traveling if you need medical attention.
The Quick Checklist
- Plan ahead and anticipate problems.
- Keep emergency contact numbers for your PH nurses and physicians with you.
- Ask your PH doctor for a letter describing why you need to carry your medications, pump and/or oxygen with you. If carrying oxygen, you will need a medical certificate from your doctor that describes why you need oxygen and the flow rate per minute.
- Contact the airline prior to booking a flight to determine the policies on in-flight oxygen or POCs.
- Allow extra time to maneuver through the ticketing area and security checkpoints and to reach the gate.
- Use transport assistance whenever possible to and from the gates. Most airlines can arrange to have a wheelchair available at each connection point if given notice.
- Carry a “reserve” of medications with you (in carry-on luggage) in case your luggage does not make it to your final destination in a timely manner.
- Be active every one to two hours to prevent blood clots. Stop frequently or get up and move around.
- Have fun and enjoy your trip!
Additional PHA Travel Resources
Answer provided by Eric R. Fenstad, MD, Cardiovascular Fellow, Mayo Clinic Division of Cardiovascular Diseases and Internal Medicine, Rochester, Minn.
This article was first published in Pathlight Summer 2012.