Guidelines for Air Travel In the Neuromuscular Patient

Abstract

Introduction: Patients with neuromuscular disease may present as a complication of their respiratory disease a chronic hypoventilation syndrome due to the neuromuscular inability of their respiratory system. Exposure during the flight to a hypoxic environment may originate an acute decompensation in these patients. Nevertheless, the only absolute contraindications to flying are active pneumothorax, bronchogenic cysts and severe pulmonary hypertension.

Purpose: Set guidelines for the individualized assessment of patients with neuromuscular diseases prior to flight, benefit of oxygen supplementation and need for assistive equipments.

Material and Methods: Review of current literature on the topic of medical management of air travel in patients with respiratory disease being given special attention to the implications in patients with neuromuscular diseases. A search was held in meta-search engines TRIPdatabase, SUMsearch and in the bibliographic database Medline/PubMed.

Results: The physician is responsible to assess the patient’s fitness to fly and possible benefit of supplemental oxygen and other assistive equipments. For decision making, the physician will perform a clinical evaluation and, if necessary, an additional functional assessment, comparing the results with the current recommendations. Clinical evaluation includes history taking, measurement of peripheral saturations and, if justified by history, blood gas evaluation and/or spirometry. The functional assessment includes the 50-meter walking test, hypoxemia prediction equations and simulation tests of hypoxia at altitude.

Conclusion: Flying is necessary in many socio-professional contexts. The physician (often the Physiatrist) must be aware of the flight effects on patients with neuromuscular diseases, knowing how to assess and decide based on current recommendations for air travel medicine.