The flight carrying a lady traveling to Dhaka from Doha had to make emergency landing at Nagpur’s Dr Babasaheb Ambedkar International Airport as she suffered from some respiratory problem. Nagpur hospital treated her and she recovered. This delayed the flight plus the lady, too, had to go through hardships later on to travel to Dhaka. This is usual scene. The air travel fitness assessment has now become a necessity. Earlier, this service was not available in Nagpur and people had to fly to Mumbai to procure the same. Now, one can get the assessment done in city and get the certificate of fitness. Apart from procuring the certificate, the travellers would get the medical advice too. Close to 44,000 in-flight medical emergencies occur each year among passengers making air travel, with few dying mid-air. Commercial aircraft typically operate at cruising altitudes of 30,000 to 40,000 feet. As altitude increases, ambient air pressure decreases, leading to a decrease in oxygen tension.

 

 

Flying at high altitude can induce significant oxygen reduction in patients with underlying lung and heart disease, despite the pressurisation of airliner cabins. Many air travellers have underlying medical conditions, including pulmonary disease, and are at risk for adverse cardiopulmonary events related to oxygen desaturation. With the ongoing CoVid-19 pandemic and many passengers having post Covid-19 lung complications, airlines refuse to board wheelchair-bound passengers nowadays with oxygen support unless they have an air travel fitness certificate. Individuals with normal cardiorespiratory function do not suffer from any symptoms despite a drop of 3-5% of oxygen concentration that typically happens at high altitude flying in a commercial aircraft but can be a matter of life and death in a cardiorespiratory status compromised passenger who has not undergone air travel fitness assessment and prescribed appropriate treatment before taking flight. Air travellers are usually sedentary during flight, thus reducing the likelihood of symptoms associated with lower flight oxygen pressure. However, in vulnerable patients, even modest exercise or activity like walking up the aisle to use lavatory during flight under low oxygen conditions may cause substantial worsening of oxygen in the blood leading to cardiorespiratory events. Untill now passengers needed to go to a Metro city to get an air travel fitness assessment done and get a certificate for safe air travel which is now frequently being demanded by international airlines.

 

This may change with recently opened Advance Lung Care Centre at Dhantoli, which has started the facility of doing hypoxia challenge tests simulating in-flight oxygen pressure and advising about precautions for such vulnerable patients, including correct prescription of supplemental oxygen to be prescribed during their air travel. The assessment includes careful extraction of pre-existing diseases history, measurement of baseline spirometry, six-minute walk test and hypoxia altitude simulation test (HAST ). The hypoxia altitude simulation test, also known as the high altitude simulation test or hypoxia challenge test, involves inhalation of a mixture of nitrogen with oxygen at a concentration of 15.1 per cent simulating the oxygen concentration that an individual would breathe at an in-flight cabin altitude of 8000 feet and then measuring arterial blood gas before and after to decide on air travel fitness advising prescription of in-flight oxygen supplementation if needed.

 

During the test, the patient is monitored closely for breathlessness, chest pain, or other change in symptoms or vital signs. If required, an additional arterial blood gas sample or pulse oxygen saturation during mild exertion (e.g., walking, sit-to-stand, or step exercises) while the patient is breathing the low oxygen gas mixture can be undertaken to simulate different normal passenger activities occurring during flight.After the assessment, supplemental oxygen is suggested for individuals whose in-flight resting arterial partial pressure of oxygen is predicted to be less than a certain value. This includes patients who require long-term oxygen therapy at baseline.Persons who are advised to take this assessment before they embark on a flight journey includes patients with a history of breathlessness, chest pain during air travel,inability to walk 50 meters without respiratory distress, high CO2 concentration in blood, abnormal lung function test result done previously, Bullous lung disease, lung fibrosis, interstitial lung disease, chest wall abnormality, respiratory muscle weakness, Cerebrovascular or cardiac disease, exacerbation of chronic lung disease requiring hospitalization in past, Pulmonary hypertension, blood clotting conditions and patients of very severe asthma and Chronic Obstructive Pulmonary Disease ( COPD ).Advance Lung Care Centre ( ALCC ) is situated on the ground floor in Shop # 18, Vijayanand Society, Dhantoli , and is the unique venture of Unik Klinical Research Services Private Limited’s.

 

ALCC is the first and only Lung Care Centre in Central India housing the latest diagnostic equipment to assess complete lung functions under one roof like testing diffusing capacity of the lung, Airway Oscillometry (IOS), Fraction of Exhaled Nitric Oxide in breath ( FeNO), Allergy Skin Prick Test, Six Minute Walk Test, complete lung volumes by Body Plethysmography, Air Travel Fitness Assessment, Post Covid Lung Sequalae care and rehabilitation. Dr Rajesh Swarnakar, Chief Pulmonologist and Director of Getwell Hospital, appreciated opening such a ‘state of the art’ centre for lung care at Nagpur, obviating the need for patients to go to bigger cities for advanced lung care. Dr Avinash Gandhare, Pulmonologist at Suretech Hospital, observed that such advanced centers are boon for many post covid patients who had pre-existing respiratory diseases. Dr Abhishek Faye, Interventional Pulmonologist at American Oncology Institute, commended opening of this independent lung function testing labs where all Pulmonologists and Physicians can send their patients for cardiorespiratory assessment tests.