Breaking news: a 61-year-old mother suffering from hypertension died suddenly on the plane. These 4 types of people should be especially careful when flying!

Airplane travel has become a part of modern life. Whether it is a long-distance trip, a business trip, or going home to visit relatives, airplanes provide a convenient means of transportation. However, not everyone is suitable for flying.

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Recently, a 61-year-old man with hypertension died suddenly on a plane and became a hot topic. The cause is under investigation. The high-altitude flight environment is special. The lower air pressure, lower air humidity and reduced oxygen content in the cabin may cause additional risks. How to avoid such situations is very important for each of us.

So, what health issues make flying unsuitable?

Recent surgery or severe trauma:

Flying may make your condition worse

If you have recently had surgery or suffered a serious trauma, air travel may not be a wise option. There are three main concerns:

(1) Although the air inside modern aircraft is pressurized, the internal air pressure during flight is equivalent to an altitude of 1,500-2,500 meters, which is much better than an altitude of 10,000 meters, but it is still a low-pressure environment compared to the ground. This low pressure may cause gas expansion inside the wound or surgical site, or displacement of implanted objects.

(2) Reduced cabin pressure reduces oxygen partial pressure (Dalton’s law), thereby exacerbating hypoxemia, which is a challenge for patients undergoing cardiopulmonary surgery.

(3) Due to the low relative humidity in the cabin, dehydration increases the risk of postoperative deep vein thrombosis.

Therefore, people who have undergone surgery or trauma should postpone their air travel plans. The time restrictions required for different surgeries vary, and you need to discuss this with your surgeon, such as↓

The latest guidelines from the American Aerospace Medical Association state that "pneumothorax is an absolute contraindication to air travel" and recommend that air travel be postponed for 2 to 3 weeks after uncomplicated chest surgery.

You should wait at least 2 weeks after stapedectomy before flying, and perform a gentle Valsalva maneuver (i.e. exhaling with your mouth and nose closed) every 4 minutes or so during descent to reduce air pressure changes in the middle and inner ears.

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In addition, patients who are about to undergo surgery, especially those who will have limited mobility after surgery, should also avoid long-distance flights. A study by the Mayo Clinic found that about 13 days after flying more than 5,000 kilometers, patients who underwent major surgery (head and neck surgery, chest and vascular surgery, abdominal surgery) had a higher risk of deep vein thrombosis in the lower extremities than patients who did not take long-distance flights.

Severe cardiopulmonary disease:

Special circumstances may bring risks

For passengers with cardiopulmonary diseases, flying may bring additional health risks, and patients with different cardiopulmonary diseases need to understand different coping measures.

Due to the low oxygen environment in the cabin, patients with coronary heart disease may be at risk of angina or myocardial ischemia. Those with uncontrolled conditions should avoid flying, and patients with recent myocardial infarction should postpone flying for at least 2 weeks until their condition stabilizes. During the flight, avoid strenuous activities, choose an aisle seat, and carry necessary medications, such as short-acting nitroglycerin. Before long-haul flights, it is recommended to confirm with a doctor whether additional examinations are needed, especially for patients with a recent history of myocardial infarction.

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Hypoxic environments may aggravate the symptoms of patients with heart failure, especially during long-distance flights. Patients with severe heart failure (such as NYHA III or IV) should avoid flying; if their condition is stable and they do not need additional oxygen support, they should still avoid excessive fatigue, try to choose short-distance flights, and avoid emotional stress during takeoff and landing. They should also avoid high-salt foods and excessive caffeine and alcohol during the flight to avoid aggravating symptoms.

In addition to the low oxygen environment, the noise during flight can also cause blood pressure fluctuations. Therefore, people with unstable blood pressure should avoid flying. When flying, you should avoid high-salt foods, excessive caffeine and alcohol, wear loose clothing, and do regular lower limb exercises to promote blood circulation. When flying long distances, get up and walk every two hours.

Patients with NYHA class I or II pulmonary hypertension can usually fly safely without additional oxygen support; however, patients with NYHA class III or IV or who already require oxygen support on the ground should avoid flying.

People with uncontrolled respiratory diseases or recent attacks, such as COPD, asthma, and interstitial lung disease, should avoid flying until their condition is under control and should carry the necessary medications with them. Asthma patients and allergic rhinitis patients should also avoid eating foods that may trigger allergies before flying and inform the airline of their allergens and medical history.

Neurological disorders:

There is no clear medical consensus

For neurological conditions, current advice is to wait at least 2 weeks after a stroke, 2 days after a transient ischemic attack, and after a seizure, wait at least 24 hours before flying and carry emergency medication.

However, recent studies have found that patients with non-hemorrhagic cerebrovascular accidents who have no complications and recover well can fly if they enter the rehabilitation stage and are assessed to have no short-term risk of recurrent stroke.

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There is currently a lack of authoritative medical consensus in this regard, but it should be pointed out that long flights of more than 4 hours, unnatural neck postures and turbulence during the journey may increase the risk of stroke in patients with carotid artery disease.

Communicable diseases: may endanger the safety of oneself or others

Infectious disease patients can also pose a hazard during flights. If you are experiencing infectious diseases such as influenza, measles, tuberculosis, etc., the closed cabin environment during the flight makes it easy for the germs to spread through the air to other passengers.

This not only increases the risk of infection for others, but may also worsen the patient's condition. In such cases, patients should wait until the acute phase of the disease is over and their condition is stable before considering traveling.

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Before flying, you can read the airline's passenger health guide in detail. For any disease that has not yet stabilized, you should consider postponing your flight plan. Before traveling, you should consult a doctor and the airline to avoid inconvenience or even danger to yourself. Only by reasonably assessing your health status and making scientific decisions on travel methods can you ensure a smooth journey and safe arrival at your destination.

References

[1]Cassivi SD, Pierson KE, Lechtenberg BJ, et al. Safety of air travel in the immediate postoperative period after anatomic pulmonary resection. J Thorac Cardiovasc Surg. 2017;153(5):1191-1196.e1.

[2]Akhal T, Bassim M. Flight After Stapes Surgery: An Evidence-Based Recommendation. OTO Open. 2023;7(3):e65.

[3]Gajic O, Warner DO, Decker PA, et al. Long-haul air travel before major surgery: a prescription for thromboembolism? Mayo Clin Proc. 2005;80(6):728-31.

[4]Hammadah M, Kindya BR, Allard-Ratick MP, et al. Navigating air travel and cardiovascular concerns: Is the sky the limit? Clin Cardiol. 2017;40(9):660-666.

[5]Okyay K. Systemic arterial hypertension and flight. Anatol J Cardiol. 2021;25(Suppl 1):7-9.

[6]Coker RK, Armstrong A, Church AC, et al. BTS Clinical Statement on air travel for passengers with respiratory disease. Thorax. 2022;77(4):329-350.

[7] UK Civil Aviation Authority. https://www.caa.co.uk/passengers-and-public/before-you-fly/am-i-fit-to-fly/guidance-for-health-professionals/neurology/

[8] China Southern Airlines. https://www.csair.com/newh5/cn/tourguide/booking/orders/order/HealthGuide/?utm_source=chatgpt.com

[9]Anugrah Dwi Riski , Monica Djaja Saputera , Rachmy Hamdiyati, et al. Deterioration and Recurrence in Flight Passengers with Ischemic Stroke: An Evidence Based Case Report. Korean J Aerosp Environ Med 2023; 33(4): 121-128

[10]Barros A, Duchateau FX, Huff JS, Verner L, O'Connor RE, Brady WJ. Nonurgent commercial air travel after nonhemorrhagic cerebrovascular accident. Air Med J. 2014;33(3):106-8.

[11]Álvarez-Velasco R, Masjuan J, DeFelipe A, et al. Stroke in Commercial Flights. Stroke. 2016;47(4):1117-9.

Planning and production

Author: Jiang Yongyuan, Master of Internal Medicine, Third Military Medical University

Reviewer: Tang Qin, Director of the Science Popularization Department of the Chinese Medical Association, National Health Science Popularization Expert

Planning丨Fu Sijia

Editor: Fu Sijia

Proofread by Xu Lai and Lin Lin