Dealing with Asthma Aloft
April 1, 2019
Back in September of 2015 on a trans-Atlantic Air Canada flight a two year old asthmatic boy started to develop cough, wheezing and progressively worsening shortness of breath. The parents had put the kid's asthma medicines in their checked luggage. Duh! Fortunately the aircraft medical kit had oxygen and some asthma medication. Even more fortunately a Canadian doc who specialized in medical robotics was on board. He jerry-rigged a makeshift nebulizer, using a plastic carton and a paper cup to allow the asthma medicine to be delivered. The child recovered. Other passengers have not been as fortunate. There are several documented cases of fatalities in commercial flight due to asthma. Fortunately that's pretty unusual. Nevertheless the recent upsurge in popularity of "emotional support" animals may well transform a potentially serious problem from an infrequent to a fairly common one. You may recall that the airlines are starting to let all manner of critters into the passenger cabin. Having these furry friends aloft might be nice for those tender souls that have fear of flying but it will definitely create fear in the hearts of those asthmatics allergic to animals.
Bronchial asthma is a lung disease characterized by constriction of the airways in response to any one or a combination of stimuli. Infection, chemical irritants, air pollution or allergy causing materials if inhaled will irritate the airways, causing constriction. This leads to chest tightness, cough, wheezing and worsening shortness of breath. If untreated, this can lead to hospitalization or even death. Nearly 25 million Americans suffer from asthma. There are more than 3,300 deaths due to asthma each year. In addition, asthma is indicated as a "contributing factor" for nearly 7,000 other deaths each year. Obviously it is a common problem and one that you as a pilot may well have to deal with among your passengers.
What should you be doing if you are asthmatic and going to fly? First of all make sure your asthma is under good control. If you have to use a rescue inhaler more than twice a week, it's not well controlled. You need to see a doctor, preferably an asthma specialist. If you have pet allergies, ask the airline if they have "pet-free" flights. If you have a cold, keep in mind that this is often a trigger for bad asthma. Consider postponing your flight. When you fly, make sure you have all of your asthma medications in your carry-on. If you are flying GA especially in an unpressurized cabin consider the use of supplemental oxygen above 5,000 ft. MSL. Let you pilot know in advance so there are no nasty surprises in mid-flight.
If you are a GA pilot it's always a good idea to chat with your passengers, asking if they have any medical issues. If they do have asthma make sure they have all their medications readily available. If you are planning a flight above 5,000 ft. it's good to have an oxygen cylinder on board if you don't have O2 built in. Remember that a pressurized cabin usually goes up to about 8,000 ft. If your cabin is unpressurized oxygen might be an even more critical need. If you are a pilot flying the heavy metal under Part 121 you will have a few more resources. Your medical kit should contain oxygen and a face mask to deliver it to an adult. Also there usually is epinephrine (Adrenaline) which can help to open up constricted airways. It never hurts to get on the PA and ask "is there a doctor in the house?" A medical consulting service called MedAire is on call for about one-third of the world's commercial flights. They can usually get you in touch with a doc that knows something about asthma, although even with the expert advice your in-flight resources for treatment are going to be slim. That leads to the next crucial decision you will have to make as Pilot in Command. Do you divert? Keep in mind that you have a passenger that is trapped in a metal tube breathing recirculated air containing all the effluents of his fellow passengers and maybe a big dose of dog or cat dander. Each breath is more and more difficult. He's slowly suffocating. Hopefully by now you're on the blower with ATC asking for the nearest suitable runway. Oh and if you dispatcher gives you any grief after landing, send him over to Ol' Doc Lakin. I'll give him an earful!
Fly wisely. See you next month!
As always, comments, questions and suggestions are welcome: firstname.lastname@example.org.