Tag Archives: COPD

Doc: When Is It Safe for Me to Fly?

You may get this question from patients with respiratory compromise — from kids with cystic fibrosis to adults who have chronic obstructive pulmonary disease.

(Courtesy Mattes/WikiMedia public domain)

So what should you tell them? It depends. Ask where they are going, how long the flight(s) is, and about any previous air travel experiences.

Increased cabin pressure and susceptibilty to micro-organisms in re-circulated air are the two main clinical concerns, said Dr. Susan Millard, a pediatric pulmonologist at Helen DeVos Children’s Hospital in Grand Rapids, Michigan.

Ensure your patient passes a walk test. They will likely need this functional capacity to do some limited walking in the airport and to get through security screening (getting through screening is challenging enough, even without any pulmonary issues).

TSA rules for portable oxygen concentrator use are outlined in the agency’s recommendations for travelers with hidden disabilities.

Dr. Susan Millard (photo by D. McNamara)

“Cystic fibrosis patients will ask us to develop a letter, which is especially important if they are going through customs,” Dr. Millard said at a pediatric pulmonology seminar sponsored by the American College of Chest Physicians and the American Academy of Pediatrics in Fort Lauderdale, Fla. Include the patient’s contact information, insurance policy numbers, and physician or clinic telephone numbers. Some airlines require physicians complete a form in advance of the patient’s traveling, so advise your patient to check their airline requirements before ticket purchase, she added.

Waiting at least 6 weeks after lung surgery or major intervention is advised in Eurpoean recommendations on traveling with cystic fibrosis released in December 2010. This consensus statement addresses preparations for travel (e.g., vaccinations, packing medication); important considerations during travel; and issues specific to the immunocompromised. Absolute contraindications for travel also are outlined.

Scientists are looking for ways to reduce every traveler’s exposure to airborne pathogens, Dr. Millard said. For example, one study shows commercially-available biosensors are not sensitive enough to detect airborne biological contaminants, at least not in a meaningful way. You would have to be on a flight with at least seven infected passengers either coughing 20 times per hour or sneezing four times an hour to get the bacteria levels up to detectable levels. And no sensor in the study worked well with airborne viruses.

In the meantime, developing better sensors or screening individual passengers for infectious respiratory illness prior to boarding would be the best approaches, she said.

Also, don’t forget to fasten your seatbelt.

–Damian McNamara (@MedReporter on Twitter)

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Filed under Allergy and Immunology, Blognosis, Family Medicine, Hospital and Critical Care Medicine, IMNG, Infectious Diseases, Internal Medicine, Pediatrics, Primary care, Pulmonary Diseases and Sleep Medicine, Thoracic Surgery

In the Developing World, Diseases Defy Definition

Before last week, I thought I knew the definition of “noncommunicable disease.” Then I attended “The Long Tail of Global Health Equity: Tackling the Endemic Non-Communicable Diseases of the Bottom Billion.”

 Held on the campus of Harvard Medical School in Boston March 2nd and 3rd, the 2-day conference was sponsored by Partners In Health, an international nonprofit organization that conducts research, does advocacy, and provides direct health care services for people living in poverty around the world. The “Bottom Billion” of the meeting’s title refers to the world’s poorest people living on less than $1 per day.

 In a 2008-2013 action plan, the World Health Organization refers to “the four noncommunicable diseases – cardiovascular diseases, diabetes, cancers and chronic respiratory diseases and the four shared risk factors – tobacco use, physical inactivity, unhealthy diets and the harmful use of alcohol.” Together, these conditions account for approximately 60% of all global deaths, of which 80% occur in low- and middle-income countries. 

A cancer patient in Rwanda receives chemotherapy as her husband and physician discuss her treatment / Photo courtesy of Partners In Health

But as I learned at the conference, among the Bottom Billion, rheumatic heart disease is often the result of an untreated streptococcal infection early in life, diabetes is frequently associated with malnutrition rather than over-nourishment, and cervical cancer due to human papillomavirus is far more common than in the developed world, where women routinely receive PAP screenings and a vaccine can now also prevent the infection.   

And most startling to me: Among the world’s poorest, smoking is not the most common cause of chronic obstructive pulmonary disease. Cooking with biomass fuels is.   

Individually, these and other so-called “endemic NCDs” including Burkitt’s lymphoma, sickle cell disease, and tropical diseases are far less common than those within the WHO’s “four-by-four” definition. But together, that “long tail” of chronic conditions contributes to a great deal of suffering. 

In May 2010, the United Nations announced that it would hold a high-level meeting on NCDs in 2011, now set for September 19-20. It will be only the 29th such meeting that the UN has ever held (formerly called “special sessions“), and just the second pertaining specifically to a health issue. The first one, the 2001 Summit on HIV/AIDS, is credited with focusing global attention and obtaining public and private funding for that cause. 

Speakers at the Partners In Health meeting stressed that the NCD movement should not be undertaken as an “us against them” competition with infectious disease for scarce resources. In a statement that will be presented to the heads of government at the UN summit, the group called instead for “strengthening and adjusting health systems to address the prevention, treatment, and care of NCDs, particularly at the primary health care level.”

—Miriam E. Tucker (@MiriamETucker on Twitter)


Filed under Alternative and Complementary Medicine, Cardiovascular Medicine, Dermatology, Endocrinology, Diabetes, and Metabolism, Family Medicine, Gastroenterology, Health Policy, Hematology, IMNG, Infectious Diseases, Internal Medicine, Neurology and Neurological Surgery, Obstetrics and Gynecology, Oncology, Pediatrics, Primary care, Pulmonary Diseases and Sleep Medicine, Uncategorized