Summer is just around the corner and vacation time is approaching. The Demoskopika Institute estimates that there will be more than 442 million Italians traveling this year and many of them will choose air travel as their mode of transportation.
Travel by air is convenient, allowing one to travel long distances in a short period of time, but before buying an airline ticket, it is important to know and be able to deal with the inconveniences that may arise if one is in non-optimal health. Airlines, in general, are very careful to meet the needs of customers so as to minimize risks to passengers with any health problems.
In the majority of passengers, air travel does not cause any adverse health effects; however, in the case of people with previous medical conditions, it is recommended to plan ahead for travel, taking all possible precautions and, if necessary, talk to the attending physician.
Transmission of infectious diseases
After the spread of Covid-19, one of the main concerns of air travelers is the transmission of infectious diseases. Scientific research has shown that, aboard an airplane, the possibility of transmission of infections is very low because the quality of cabin air is healthy and carefully controlled,because it is recirculated and filtered frequently. There are, in fact, high-efficiency filters that ensure excellent air quality. Exposure to pathogens, if it occurs, is possible by direct proximity between passengers seated in the same area of the aircraft, just as on a train, car, or bus. The infection is spread by airborne droplets of saliva dispersed by people with the infectious disease while talking, or by respiratory tract secretions such as sneezing and coughing. These viruses can also be found on hands and be transmitted by touching the same surfaces or objects or by common gestures such as a handshake. Recommended prevention measures for travelers are to adopt proper hygiene behaviors such as washing hands thoroughly with 60% alcohol-based disinfectant. For this reason, it is very important not to travel if you are aware that you have an infectious disease.
In the same way, by direct proximity between passengers, but in a different way, pediculosis (parasitosis caused by lice), scabies etc.
can be transmitted.Altitude and pressurization: be careful if you have heart disease
.A passenger airplane generally can reach a flight altitude between 10,000/11,000 m above sea level. At these altitudes temperatures are very cold and oxygen pressure very low, conditions that put the lives of passengers at risk so it would not be possible to fly. For this reason, aircraft cabins are pressurized and pressure is maintained at a value that is equivalent to an altitude of 1800-2400 meters resulting in a decrease in oxygen (about 25% less than usual). Low oxygen concentration is usually well tolerated, but may contribute to cardiovascular risks in predisposed persons, for example, in those suffering from angina pectoris, heart failure, atrial fibrillation, BPCO (chronic obstructive pulmonary disease), cystic fibrosis, asthma. Inhaling air with reduced oxygen content in a pressurized place means less oxygen circulation in the tissues, a phenomenon known as "hypobaric hypoxia." Hypobaric hypoxia causes, in the human body, a reduction in oxygen and carbon dioxide, an increase in heart and respiratory rate, blood pressure and lung pressure so the body must put measures in place to counteract it. In the case of people with a history of cardiac, vascular, or pulmonary health, the body, already debilitated by the disease, is required to make a major effort to adapt, which may evolve into a cardiovascular risk.
The British Cardiovascular Society has compiled a document with scientific data to reassure travelers with heart problems by clarifying that, air travel, is not precluded for individuals with heart disease because the onset of cardiovascular events depends on the degree of stability of the clinical picture and the individual's ability to adapt the cardiovascular system. Even carriers of cardiac devicesi (pacemakers or defibrillators) can face travel by air, taking, however, certain precautions not because of the type of device implanted, but because of the problem that made it necessary to use the device.
When it is inadvisable to fly for cardiac device wearers
.It is essential that the heart disease that required implantation of the device is under control so it is not recommended to fly:
- to individuals with a defibrillator for ischemic heart disease, characterized by narrowing of the arteries that carry blood to the heart. As altitude increases, the air is thinner, and therefore less oxygen-rich. This poor oxygen supply, added to the difficulties by the arteries to oxygenate the heart, can promote the onset of cardiac ischemia;
- if the defibrillator was activated in the days before the trip to prevent, for example, an arrhythmia that could cause severe complications;
- after implantation, the leads, in fact, need time to become stably fixed. After a month to a month and a half has elapsed, a follow-up is generally performed to check the function and stability of the leads and the device; if everything is normal, you can fly.
Cardiac device wearers should always carry their device ID badge and notify security personnel to avoid the metal detector; checks are performed manually, although recent studies have found no significant interference between the control device and the cardiac device.
It is also important to inform flight attendants about their own health condition so that they can intervene if the defibrillator delivers an electric shock, which knocks people unconscious, to restore the heartbeat.
Remember that these state-of-the-art devices are not altered by cosmic radiation, described below: in fact, the intensity of the radiation is similar to that of a chest X-ray. They have no interference with on-board instrumentation, and there is no need to reprogram them.
Short-acting bronchodilators and therapeutic oxygen
Those suffering from pulmonary diseases, in an environment of low oxygen and humidity, may experience exacerbation of symptoms associated with respiratory problems. Consulting a pulmonologist and undergoing spirometry before air travel may prove helpful in flying safely. In addition, the specialist, depending on the outcome of the respiratory test, may recommend the use of short-acting bronchodilators or therapeutic oxygen on board, provided by some companies. Patients with severe respiratory disease should undergo a careful clinical evaluation before embarking on air travel; only the physician or specialist, in fact, can certify suitability by taking into account numerous variables based on the individual's health condition.
Economy Class Syndrome
.Economy Class Syndrome or Traveler's Thrombosis is a pathological picture characterized by edema in the lower extremities that can affect both travelers and flight personnel. It is caused by water retention for long trips (more than 8 hours) by airplane; other important concomitant causes are immobilization in confined spaces, pressurization of travel rooms, and poor hydration. Those most affected may be people who are already predisposed or who suffer from venous insufficiency, but sometimes also healthy patients without a family history. This syndrome causes venous overload with blood stasis that predisposes to the formation of blood clots in the veins of the lower extremities (thrombosis).
It can manifest, as described above, with simple leg swelling or evolve into phlebitis, thrombosis or thromboembolic pathology.
The main recommendations for reducing the risk of traveler's thrombosis are:
- stand up whenever possible, walking down the aisle of the plane;
- wear compression stockings;
- stretch your legs at least every hour;
- wear loose, comfortable clothing;
- don't stow luggage under the chair in front so you can stretch your legs and move your ankles and feet;
- contract your calves rhythmically;
- take a proper intake of fluids, water or fruit juices to avoid poor hydration; conversely, coffee or alcoholic beverages are not recommended as they promote diuresis and can cause dehydration.
Beware of cosmic radiation
.During a flight leg that involves passing over the atmosphere, in the stratosphere, 36,000 feet up, there are high-energy particles called cosmic rays. When we are on earth these rays arrive to a lesser extent because they are shielded by the atmosphere, but at an altitude of 11,000 feet they can penetrate the aircraft and pose a health risk. A study conducted by NASA found that the higher the altitude, the more radiation increases. Those most exposed to the intensity of these space photons are the astronauts who are in space, but also, albeit to a lesser extent, flight personnel and those who must travel frequently for work. These people are subjected to nearly twice as much radiation as those who work on earth. On intercontinental routes, for example, one can reach an altitude of 45,000 feet; in 5 hours of flight time, one can absorb, approximately, an amount of radiation comparable to that of a dental x-ray. The potential health risk, therefore, depends on how the radiation exposure occurred and the duration, which can cause transformations of cells and consequently promote the development of tumors.
Shocks of pressure can cause barotrauma
.During takeoff and especially landing, it is possible to experience the sensation of closed ears; this phenomenon, known as barotrauma, is caused by the variation of pressure between the ear and its surroundings. Usually, the pressure inside the ear is equal to the atmospheric pressure; in an airplane, however, the pressure inside the ear is greater than in the cabin, and this imbalance pushes the eardrum membrane outward causing the "plugged" sensation that can sometimes cause pain in the ears. Barotrauma occurs, generally, during airplane landing and, to alleviate the symptoms, some practical tips can be put in place:
- avoid falling asleep during landing and takeoff;
- use earplugs so as to compensate for pressure;
- chew candy or chewing gum;
- badly yawn often;
- sip water.
These measures promote the opening and closing of the Eustachian tube (a canal that connects the middle ear to the nose and helps compensate for the pressure of outside air on the eardrum) and level the pressure between the middle ear and the outside environment.
There are also some maneuvers that can be performed with caution so as not to create too much pressure on the eardrum:
- Edmonds maneuver: bring the jaw forward and backward, side to side;
- Valsalva maneuver (forced exhalation with nose and mouth closed, for about 10 seconds);
- Toynbee maneuver: sip water with the nose closed.
If the passenger is a child, to encourage swallowing and avoid the discomfort of a closed ear, you can give him a candy, pacifier, lollipop, or try to get him to sip water or milk from a baby bottle and try to keep him awake during takeoff and landing.
