Historia

RECOMMENDATIONS OF THE SPANISH SOCIETY OF PULMONOLOGY AND THORACIC SURGERY (SEPAR)

Air Travel and Respiratory Disease
Francisco García Ríoa (coordinator), Luis Borderías Clau,b Ciro Casanova Macario,c Bartolomé R. Celli,d Joan Escarrabill Sanglás,e Nicolás González Mangado,f Josep Roca Torrent,g and Fernando Uresandi Romeroh
a

Hospital Universitario La Paz, Madrid, Spain. Hospital SanJorge, Huesca, Spain. c Hospital Universitario La Candelaria, Santa Cruz de Tenerife, Spain. d St Elizabeth’s Medical Center, Boston, MA, USA. e Hospital de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain. f Fundación Jiménez Díaz, Madrid, Spain. g Hospital Clínic, Barcelona, Spain. h Hospital de Cruces, Baracaldo, Vizcaya, Spain.
b

Rationale In recent years there has been a progressiverise in the number of people who travel by air. According to data from the International Civil Aviation Organization, 1647 million people traveled by air in 2000 and, despite problems related to security restrictions and severe acute respiratory syndrome (SARS), it is anticipated that the number of passengers will increase annually by 4.4% until 2015.1 More than 2 million air traffic operations werehandled during 2005 in airports managed by the Spanish aviation authority (Aeropuertos Españoles y Navegación Aérea, AENA), representing travel by 179 million passengers.2 Those figures correspond to a 29% increase in the number of passengers since 2000, with an annual increase of 6%.2 In addition, advances in the monitoring and treatment of many chronic respiratory diseases have allowed changesin the lifestyle of patients. Thus, patients are now able to consider leisure and professional activities that were not possible some years ago. Although adverse respiratory events as a result of air travel are not common, this form of transport does present potential risks.3 Data from 120 airline companies forming part of the International Air Transport Association (IATA) show that between 1977and 1984 there were 577 deaths in flight, corresponding to 0.31 deaths per million passengers or 25.1 deaths per million takeoffs.4 Respiratory complications represented the third highest known cause of death (7%) after cardiac causes (65%) and deaths due to cancer (9%).4 In addition, it was noteworthy that while there was prior knowledge of the presence of heart disease in only 22% of deaths dueto cardiac events, there was prior knowledge in 46% of those due to respiratory disease, suggesting that there are problems in the assessment of patients prior to the flight or in their in-flight care.4

Aside from fatal events, respiratory symptoms are responsible for a good proportion of the emergencies that occur on board aircraft. Analysis of all 2322 cases in which the first-aid kit was usedon commercial aircraft belonging to the IATA between August 1984 and July 1988 showed that chest pain and dyspnea were 2 of the 3 most common causes, along with loss of consciousness.5,6 Likewise, 62% of passengers who required medical assistance had a known medical condition associated with the episode that occurred on board the aircraft,6 further indicating the importance of careful assessmentprior to flight. Along similar lines, a service offering the assistance of experts by radio during in-flight emergencies received 8450 calls in 2001, of which 11% corresponded to respiratory problems.7,8 Thus, respiratory problems may represent up to 11% of in-flight emergencies. In response to this situation, various guidelines and recommendations have been prepared by scientific societies or theairline companies themselves.7,9-17 However, little scientific information supported by a high level of evidence is available in this field, meaning that the majority of the recommendations are based solely upon expert consensus. In fact, in recent years, conflicting results have been reported using the regimens recommended in previous guidelines. Furthermore, there is a local problem generated...