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Air Travel with PAH — EECC MCQ

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ModeratePulmonary Vascular DiseaseAir Travel with PAHEECC

A 45-year-old woman with PAH has been stable on oral dual combination therapy for 3 years. She plans to travel by air (10-hour flight). What advice should she receive?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Supplemental in-flight oxygen should be considered as cabin pressure at altitude (~8,000 ft equivalent) causes mild hypoxia, which can worsen pulmonary vasoconstriction in PAH; adequate hydration, compression stockings, and VTE prophylaxis are also recommended

Commercial aircraft cabins are pressurised to approximately 6,000-8,000 feet equivalent altitude, resulting in inspired PO₂ of approximately 15% (equivalent to FiO₂ 0.15). In PAH, the alveolar hypoxia further increases pulmonary vasoconstriction (hypoxic pulmonary vasoconstriction), potentially worsening PH haemodynamics. The 2022 ESC/ERS PH Guidelines recommend: (1) supplemental in-flight oxygen for PAH patients, particularly those with resting SpO₂ <92% or who desaturate with exertion (hypoxic challenge testing may be performed pre-travel); (2) adequate hydration; (3) compression stockings and possibly VTE prophylaxis (LMWH) for long-haul flights; (4) carrying an adequate supply of all medications in hand luggage.

Reference: ESC/ERS (2022): Guidelines for Pulmonary Hypertension