In-flight health

Travel preparations plus long waits at the airport, customs and baggage handling, as well as the fears many people have about flying, often mean that air passengers become stressed easily. Add to this existing medical conditions and it's a recipe for potential health problems.

Fortunately, in-flight medical emergencies (IME) are uncommon and usually minor, although about one in every 20,000 passengers does experience something serious.

A recent study found that:

• In more than 50 per cent of cases of IME the problem was just a simple faint
• About one in ten problems were related to the gastro-intestinal system
• Heart conditions accounted for one in 20 emergencies
• One in 400 were due to appendicitis
• In four per cent of cases, the medical emergency was thought to be the result of panic because of fear of flying

It was only necessary to divert the flight in about one in 30 medical emergencies.

Serious in-flight problems

Several factors may put a passenger at particular risk during a flight, mostly as a result of the cabin environment:

• Reduced oxygen availability
• Dehydration
• Immobility due to limited cabin space
• Air expansion due to air pressure changes

The amount of oxygen available within the cabin may be slightly less than normal air, so that levels of oxygen in the passengers’ blood is lower than normal. Although this difference will be tolerated well by most people, those who already have heart or lung problems may find it triggers symptoms.

People with angina, for example, may find they experience chest pains because the muscle of the heart isn't getting enough oxygen. Those with asthma or chronic obstructive pulmonary disease may find their breathing becomes a little harder or wheezy. Mild dementia or confusion can be aggravated by reduced levels of oxygen to the brain.

Blood clots in the legs (deep vein thrombosis) or lungs (pulmonary emboli) can develop during a flight although symptoms usually don’t develop until a little later, once the flight is over. Prolonged immobility and dehydration during the flight make these more likely.

Minor medical problems

Although not life-threatening, these can spoil the beginning or the end of a holiday.

At aircraft cabin pressure, the air normally present in the body cavities expands. Typical places for this to happen are the ears, sinuses and teeth, if tooth decay has caused erosion. This can result in severe pain during the flight.

In general, the air quality in planes isn't as good as the air outside, and air filters aren't always fully effective. This allows bacteria and viruses to spread easily from one person to another, which is why many people arrive on holiday or come home with a cough or cold.

Also, the air isn't humidified, which contributes to the body becoming dehydrated. This and the drying out of the protective mucosa of the mouth and nose, which normally acts as a barrier to bacteria and viruses, increases susceptibility to infection.

Travelling by plane when you have a cold can cause permanent ear or sinus damage. Ideally, you should wait until your condition improves, particularly if you have a high fever and/or ear/sinus pain. Consult your doctor about whether it's safe for you to travel - they may be able to prescribe antibiotics or decongestants.

Rapid changes in air pressure when an aircraft is ascending or descending may cause discomfort for travellers with a head cold or ear condition. Pinch the nose and, with the mouth shut, blow gently. This opens the Eustachian tube between the mouth and middle ear, allowing the pressure in this cavity to equalise. Swallowing, chewing gum or sucking sweets can also help.

If you've recently been treated for an ear condition, you should wait at least two weeks before travelling by air.

Travellers with a history of motion sickness can attempt to avoid the symptoms by taking anti-motion sickness pills before departure. As with any medication, consult your GP for specific advice.

Preventing problems

If you know you have a fear of flying, try tactics such as hypnosis or meditation to control this – in severe cases, talk to you doctor about taking a mild sedative.

Allow plenty of time to get to the airport and through check-in. Things do go wrong, so plan for this. Make use of luggage trolleys and ask for help from the airport staff if you're having difficulty. It's better to share a load than to end up with strained muscles.

Drink plenty of water during the flight. One or two glasses an hour is a good guide. It's best to avoid alcohol and caffeinated drinks, as they contribute to dehydration.

Swollen feet, aching joints and muscles, indigestion and wind all result from immobility. Every hour get out of your seat and move around for about ten minutes. Have a good stretch too.

While you're seated, jiggle your legs up and down as if you're pedalling a bicycle and try not to sit with your legs crossed. Wearing a pair of elastic support stockings helps to maintain good blood flow.

During the flight, particularly while taking off and landing, suck sweets, swallow, or hold your nose, close you mouth and try to blow. This will equalise the pressure and help avoid ear and sinus pain.

Keep any medicines you need, such as angina sprays or asthma inhalers, in your hand luggage. They're no use to you packed away in your suitcase. Keep a written list of your medical problems and the medicines you take handy so if you need assistance those helping you are aware of your situation.

Enjoy your flight

• Plan and be prepared
• Drink plenty of water
• Avoid alcohol and caffeinated drinks
• Move around the cabin
• Have essential medicines with you
• Take a list of illnesses/medicines

There's no guarantee that you won’t pick up an infection such as a cough or cold, but you can lessen your chances by keeping generally healthy before you travel.

Keep your immune system strong by getting enough sleep and relaxation, eat a healthy diet that’s rich in fruit and vegetables, exercise regularly, and don’t smoke.

Wash your hands regularly during the flight as you may come into contact with contaminated surfaces whilst moving around the cabin - if this isn’t easy then use a travel hand-sanitizer. Encourage those who are coughing and sneezing to cover their mouth and nose when doing so with a disposable tissue.