Should I give fitness for air travel to an asthmatic or a patient with heart failure?

·         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.