TRAVELING WITH PH
Before deciding to plan a trip, you’ll want to consider the effects of weather on your body. Read our Climate and PH section to learn what to keep in mind.
Planning well ahead of travel ensures that your trip is as safe and enjoyable as possible. Review your travel plans with your doctor as early as you can. Be sure to discuss the need for supplemental oxygen, the amount of medications and medical supplies you should pack and the altitude during travel and at your travel destination.
- By Air
- By Sea
- By Rail
- International Travel
- Resources for Traveling with Oxygen
- Blood Clots
- High Altitude
- Prior to departure, obtain a letter from your doctor describing the specific medical requirements of PH. This will simplify the process of obtaining oxygen and getting medicine through security checkpoints.
- Air travel can result in a decrease in the blood oxygen level. Therefore, all PAH patients planning air travel or travel to high altitude locations should discuss the possible need for oxygen with their PH specialist, even if they do not require supplemental oxygen at home. Resources for traveling with oxygen
- Obtain the name of a physician familiar with PH at your travel destination who you can contact in case of emergency. Visit PHA’s Find a Doctor section to locate a PH specialist.
- While traveling, all PAH patients should stand up and walk a short distance at least every two hours.
- Plan to take extra medicines and supplies 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 for 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 will handle flight delays or cancellations.
- PH patients traveling with pumps or oxygen can call the TSA Cares Help Line 72 hours in advance of their flight to make sure that local TSA agents are informed about any special circumstances needed for going through security.
- Reserve your seat and print out your boarding pass in advance if possible. This helps maximize your chance of getting a seat with good leg room and eases the stress of check-in. Be sure to check in well ahead of time.
- Don’t underestimate the strain of travel. Go easy on yourself, plan plenty of time during layovers and allow trusted travel companions to do as much as possible for you, such as carrying bags, using wheelchairs or arranging gate-to-gate transportation.
- Organizations like Miracle Flights may be able to provide “free flights to those in need of life-changing medical care
not found in their local communities.”
Follow the same general preparations as with travel by air. Most cruise lines require at least four weeks’ notice, but will allow patients to provide their own oxygen source (either an oxygen concentrator or a portable system). Refills of portable systems during the cruise should be pre-arranged at ports of call.
Follow the same preparations as above. Railroads allow passengers to bring portable oxygen containers or oxygen concentrators. If using a concentrator, a 12-hour battery back-up is required.
Remember to stand up and walk at least once every two hours.
In addition to the above preparations, you should determine in advance if there are any laws against bringing medical supplies into your destination country, or if special documents are needed to enter the country with medications.
Resources for Traveling with Oxygen
Travel to higher altitudes may present a 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 feet. Symptoms to look for include fatigue, increased shortness of breath at rest or with activity, rapid breathing, lightheadedness, rapid heartbeats and headaches.
If traveling by car, 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 feet. But oxygen levels are 25% 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 use a 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.
- 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.
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.
If you are considering traveling by air with oxygen, the following information may be helpful.
- List of FAA approved Portable Oxygen Concentrators (POC)
- Avoiding Pitfalls During Air travel (PDF) (Brief by Rhonda Basha, JD, Director, TSA Office of Disability Policy & Outreach)
High Altitude and PH
Whether in an airplane or on the ground, the effects of high altitude are significant for PH patients. The lower pressure in the atmosphere results in a lower level of oxygen in the blood. In both healthy people and people with PH, blood vessels in the lungs constrict at high altitude, which can cause an increase in pulmonary pressures. This can result in worsening symptoms and decreased exercise capacity in PH patients.
Research indicates that some people may have a genetic tendency to respond abnormally to low oxygen (hypoxic) environments, which can magnify these effects even more. Those on supplemental oxygen need to be particularly aware that the body’s need for oxygen increases at higher altitude.
Low humidity also plays a role in the worsening of PH symptoms. Very dry air can irritate the lungs and cause you to feel worse than usual.
Before vacationing or moving to a high-altitude location, discuss the impact of altitude with your PH specialist. If you’re thinking about moving to such a location, your doctor may suggest a trial period of residence at the higher altitude.