Businesswoman Patti Wilson flew more than 3 million miles until she was grounded by a chronic lung ailment. Now, six years later, she's one of a growing number of fliers with lung problems who are returning to the skies or flying more frequently.
Buoyed by new technology and recent airline and government initiatives, Wilson and others are using oxygen devices to breathe in-flight. "It's wonderful," says the 60-year-old Port Costa, Calif., resident who retired from her management consulting job and now flies for pleasure. "I can travel again."
Travelers with pulmonary disorders are thrilled that they have better access to the skies, making it easier to visit clients or family, even to take faraway vacations. But some medical experts say in-flight respiratory emergencies are common, and some fliers with serious pulmonary problems are not healthy enough to fly. Last year, airlines made about 2,800 calls for emergency assistance for in-flight respiratory problems, says MedAire, a company that assists most airlines.
There's also concern that the breathing devices used by passengers with lung ailments could pose some risk to other fliers. The government warns that devices should not be near an open flame and says airlines must ensure that they don't interfere with navigational and other aircraft equipment.
Chronic obstructive pulmonary disease (COPD) -- a group of diseases that includes emphysema, chronic bronchitis and in some cases, asthma -- afflicts 10 million to 24 million Americans and is a leading cause of death, illness and disability, according to the Centers for Disease Control and Prevention. More than 1 million people with COPD or another respiratory disease require supplemental oxygen for routine activities, the American Lung Association says.
Until recently, most airlines didn't provide or allow supplemental oxygen aboard planes. That made it difficult or impossible for most people with COPD to fly commercial jets. But prodded by the government to give equal access to the medically impaired, airlines began changing their policies in the past year.
The Federal Aviation Administration issued a rule last July that says airlines can allow passengers to bring approved oxygen devices aboard. Two months later, the Department of Transportation issued a proposed rule requiring airlines to allow the devices and to supply oxygen for anyone with a medical problem.
Nine of 19 U.S. airlines surveyed by USA TODAY now provide bottled oxygen for a fee, and 11 airlines allow passengers to carry on their own portable oxygen concentrators -- a relatively new product that converts cabin air into oxygen. Continental Airlines this month will become the 12th carrier to allow concentrators aboard, says spokesman Dave Messing.
Each device is about 12 inches long, 6 inches wide and 12 inches tall, and, with a battery, weighs 10 pounds. A passenger wheels or uses a shoulder pack to carry the device. The unit can be stowed under a seat in front of the passenger.
Breathing under pressure
Joan Garrett, CEO of MedAire, which provides in-flight medical assistance to about 90 airlines, supports the move to make it easier for pulmonary patients to fly. But she's worried that people with only one lung or serious breathing problems might think that an oxygen device guarantees their well-being in-flight. It doesn't, she says.
Many people with pulmonary disorders have multiple problems, such as heart disease, kidney problems and diabetes, and probably should not be on planes, Garrett says. The FAA requires that passengers have a doctor's permission before flying with an oxygen device, but Garrett says some doctors give that clearance without understanding the detrimental effects that altitude can have on an impaired passenger. Air inside an aircraft cabin is pressurized to an altitude of 8,000 feet.
"They wouldn't send their patient with a serious pulmonary problem to Denver, and they wouldn't send them on an aircraft if they knew that the oxygen level in the blood decreases at 8,000 feet," Garrett says. "The body may or may not be able to compensate, depending on the severity of the disease."
Claude Thibeault, a doctor and aviation medicine expert, agrees that most doctors aren't well-versed with cabin altitude issues. It's a "legitimate concern" whether a person with a pulmonary disorder should fly, he says.
Frederick Tilton, the FAA's federal air surgeon, declined a request for an interview, but provided written responses to questions. He says individuals with medical conditions that require oxygen "should consult with their personal physician to determine fitness to fly before contemplating air travel." Individuals shouldn't fly "if they are medically unstable, and physicians should advise them against doing so," he says.
But Paul Billings, vice president at American Lung Association, says he's not aware of any data that show a traveler with lung disease is at any greater risk in-flight than someone with another disease. New technology "holds promise to open the skies" to those with respiratory problems and should be celebrated, he says.
Garrett predicts that an increase in oxygen-assisted passengers will lead to more in-flight medical emergencies and more flights diverted for emergency landings.
MedAire's statistics show that it responded worldwide to about 100 in-flight medical emergencies each day last year. More than 2,700 were for respiratory problems, including 182 for COPD. The company consulted on 62 flights last year that made an emergency landing because of a respiratory problem.
Airlines aren't equipped to handle many types of in-flight medical emergencies. Flight crews can administer first aid and assist choking victims, Garrett says, but they aren't trained and don't have the equipment to deal with more complex illnesses.
The airlines agree that they can provide "only emergency first aid," says David Castelveter, spokesman for the Air Transport Association, which represents most big carriers.
Flight crews are given basic emergency medical training, Tilton says, and flight attendants receive instruction in cardiopulmonary resuscitation and use of an automated external defibrillator.
Air of freedom, concern
Betsy Blake, 52, of Opelika, Ala., flew about three times a month as vice president of sales for a plastics manufacturer until she was diagnosed with chronic pulmonary disease about six years ago. "It's a shock when you find out you can't live without supplemental oxygen," she says.
Last January, she took her first flight with a portable oxygen concentrator, lugging extra batteries just in case. Her trip from Atlanta to Tel Aviv, via Frankfurt, Germany, went so smoothly, she flew to Honduras last month. The trip went off without a hitch. "I'm passionate about my oxygen concentrator," says Blake. "It's restored my vibrancy and enthusiasm toward life."
Though not required to do so, some airlines began allowing oxygen concentrators on planes after the FAA approved two manufacturers' units last year. Among other conditions, the FAA requires those airlines to ensure that the concentrators do not interfere with a plane's electrical, navigation and communications equipment, and that no smoking or open flame is permitted near a passenger with a concentrator.
In comments submitted in January regarding the Department of Transportation's proposed medical oxygen rules, the Air Transport Association said safety experts have expressed concern that oxygen concentrators' batteries could short-circuit and cause a fire. The group called on the agency to adopt the FAA's stowage and packaging rules for the batteries. New technology has incorporated safeguards that prevent a fire, says Daryl Risinger, vice president of Inogen, one of the approved manufacturers. Concentrators "use the same battery technology as laptop computers," he says.
Airlines oppose a Department of Transportation proposal that would require them to provide free bottles of oxygen for passengers with lung problems. In comments submitted to the DOT this year, the Air Transport Association said it would cost $103 million annually to provide oxygen, and more to train the flight crew on its use. Providing free bottles of oxygen might also discourage passengers from bringing their own oxygen concentrators aboard, the airlines say. The concentrators store only enough oxygen for a person's next breath, says Risinger, and are safer than bottles of oxygen, which can accelerate a fire and is considered, according to DOT regulations, a hazardous material.
Trouble on board
However, the Air Transport Association also told the DOT that more oxygen concentrators on planes might lead to more medical emergencies. The group said a passenger during the past year failed to bring enough batteries for a concentrator, and an unidentified airline had to give the passenger oxygen from a back-up supply that's available for all passengers if there's a cabin depressurization. The passenger exhausted the back-up supply.
Airlines don't carry extra batteries for the units, and it's a passenger's responsibility to bring extra batteries, says Lana Hilling, lung health services coordinator of John Muir Health, a non-profit hospital and medical services center in California.
The Air Transport Association fears airlines could be saddled with extra costs for emergency landings if the DOT rule leads to more widespread use of medical oxygen in-flight. Emergency landings cost $6,000 to $100,000, the group says.
The proposed rule -- opposed by airlines -- would also require airlines to test passengers' oxygen concentrators and make sure they meet safety standards. Inogen and other manufacturers should foot the bill for such testing, airlines say.
No problem, says Risinger, who expects the DOT's proposed rule to be revised accordingly. But DOT spokesman Bill Mosley would not comment on what action the agency will take or give a date when a final rule will be issued.
The Lung Association's Billings says he understands safety and cost concerns, but air travel is "very important" to people with pulmonary disorders. It gives them "freedom of mobility," he says.
Hilling adds that air travel increases pulmonary patients' quality of life. "It gives them the ability to do what all of us take for granted."
For Tom Haderlein, 70, knocking down barriers for people who need supplemental oxygen "is a monumental improvement."
The retired resident of Kenilworth, Ill., had a lung transplant about six years ago. He says the transplant is failing, and he's on oxygen every minute of the day.
"I would like to fly," he says. "I want to see my son in Atlanta later this year."
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