· Aircrafts cabins have pressurization but flying at a high altitude can lower oxygen levels in patients with underlying lung disease.
· Patients at risk need supplemental oxygen during the flight.
· Screen such patients with pulse oximeter at rest and breathing room air.
· If SpO2 is above 95%: give them clearance. They do not need further testing. If person has serious illness but with SpO2 above 95, better to do six minutes walk test as described below.
· If SpO2 <92% : the person will need supplemental oxygen in-flight
· If SpO2 is between 92 and 95%. Look for risk factors. If absent give them clearance. If present make them undergo a six minutes walk test. During test de-saturation to a SpO2 <84 percent indicates the need for in-flight oxygen.
· If the patient is on oxygen at room air, increase the oxygen flow 1 to 2 L/minute over baseline while in flight.
· Supplemental oxygen may be derived from approved portable oxygen canisters or oxygen concentrators.
· Airlines allow use of portable oxygen concentrators throughout the flight but a medical prescription is needed.