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People with specific medical conditions encounter special problems in transit.
Heart
Disease
People with angina pectoris, heart failure, or rhythm disturbances that cause symptoms at rest or with minimal exertion should not travel. People who have had a heart attack within the past 4 weeks or a heart attack causing shock or heart failure within the past 6 weeks also are advised not to travel. People with severe or worsening angina should avoid flying because symptoms may worsen due to lack of available oxygen at high altitudes.
All travelers with heart disease should carry a copy of a recent electrocardiogram. People with pacemakers, implantable defibrillators, or coronary stents should carry a card or doctor's letter documenting the presence, type, location, and electronic characteristics of the implanted device. An implanted metal device may trigger an alarm as the person passes through electronic security. Electronic security devices do not generally affect implantable defibrillators, but travelers are advised to avoid standing in walk-through metal detectors for more than 15 seconds. Hand-held metal detectors are also safe for people with defibrillators, but prolonged contact, such as holding the detector over the defibrillator for more than 5 seconds, should be avoided.
Most major airlines can provide low-sodium, low-fat meals on flights with regular meal service if given 24 hours' notice. Many cruise lines can also provide these meals if notified in advance.
Lung
Disease
Travelers with lung cysts, severe emphysema, a large collection of fluid around the lungs (pleural effusion), or recent lung collapse or who have had recent chest surgery can develop complications caused by airplane pressure changes and should not fly without approval from their doctor.
Other travelers with lung disease may need supplemental oxygen while aboard an airplane. A doctor determines a person's need for in-flight oxygen by measuring the level of oxygen in the blood. Airlines will provide in-flight oxygen if given a doctor's prescription and 48 hours' notice. Travelers are not allowed to carry oxygen in any form aboard an airplane. Travelers who need oxygen during airport layovers must make their own arrangements, although most oxygen vendors will assist their regular customers without charge if they have services in the destination city. Other respiratory equipment, such as continuous positive airway pressure devices, can be accommodated on an airplane provided the equipment does not exceed the size allowed for carry-on luggage. However, travelers who need this equipment should allow extra time for security checks.
Travel at high altitudes may present special problems because there is less oxygen available than at sea level. In general, people with mild or moderate lung problems do not experience any difficulty at altitudes below 5000 feet, but the greater the altitude, the greater the chance of problems. People with lung disease traveling in or through such areas should take the same precautions that they would if they were flying.
Bus, train, car, and ship travel is safe for people with lung disease but requires planning to ensure a supply of oxygen. Commercial services can coordinate oxygen deliveries for travelers anywhere in the world.
People with asthma, emphysema, or bronchitis may find that their symptoms worsen in cities where air pollution is significant. They may need additional treatment from their inhalers or additional drugs, such as corticosteroids, to control symptoms adequately.
Diabetes
Blood sugar levels are best managed in transit by frequent testing, with adjustments of food intake and drug doses as needed. Travelers with diabetes should pack sugar (glucose) supplements in their carry-on bags or carry juice, crackers, and fruit for when blood sugar levels are low. If travel plans incur time changes of more than a few hours, people with diabetes, especially those taking insulin, should consult with a doctor on how best to schedule their drugs. Insulin can be stored without refrigeration for many days but should be kept out of extreme heat.
Most major airlines provide special meals for people with diabetes if given 24 hours' notice. Measures to prevent dehydration while in flight are important.
Blood sugar levels should be monitored frequently on arrival, because activities and diet often differ from those at home. Because controlling blood sugar levels precisely is more difficult while traveling, levels tend to vary more than usual. Trying to keep levels very close to normal thus increases the risk that levels may sometimes become too low. For this reason, target blood sugar levels should be somewhat higher than ideal while traveling. Diabetic travelers should adhere to established diets despite temptations to try new foods and to eat more frequently or off schedule. They should wear comfortable socks and shoes, check their feet daily, and avoid walking barefoot so as to prevent minor injuries that might become infected or be slow to heal.
Pregnancy
Pregnancy generally is not affected by travel. However, pregnant women close to their due date (over 36 weeks) and those at risk of miscarriage, premature delivery, or placental abruption should avoid flying and traveling long distances. Most airlines have policies regarding travel for pregnant women, and these policies should be checked before tickets are purchased. Pregnant women traveling long distances should take precautions to reduce the risk of blood clots (such as getting up often when traveling by airplane and stopping to take short walks when traveling by car) and dehydration. Seat belts should be fastened below the abdomen and across the hips to prevent injury to the fetus.
Vaccines that contain a virus that has been weakened but not killed—for example, yellow fever and measles-mumps-rubella—are not safe for pregnant women.
Pregnant women should avoid prolonged use of water purification tablets that contain iodine, because iodine can affect development of the fetal thyroid gland.
Pregnant women who cannot postpone travel to regions of the world where malaria is common must weigh the risks of taking protective drugs whose effects on pregnancy are not well known against those of traveling without adequate protection. Malarial infection is more likely to be serious and life threatening among pregnant women than among women who are not pregnant, even with preventive drugs.
Pregnant women are also at risk of contracting hepatitis E infection, a viral liver infection rare in the United States but common in Asia, the Middle East, North Africa, and Mexico (see The Hepatitis Viruses  ). Miscarriage, liver failure, or death may result. There is no treatment, so postponing travel to regions where hepatitis E is common should be considered. Those who cannot postpone travel should be vigilant about hand washing.
Other Conditions
Travel and transit also affect other medical conditions.
Some travelers with sickle cell disease, for example, are at risk of experiencing pain (sickle cell crisis) when exposed to the low humidity and low oxygen concentrations in airplane cabins. This risk can be minimized with proper hydration and oxygen.
People with human immunodeficiency virus (HIV) infection/AIDS are at risk of potential interactions between drugs for HIV/AIDS and those frequently taken by international travelers for the prevention of malaria and traveler's diarrhea. Travelers should discuss these risks with their doctors and pharmacists.
People with a colostomy should wear a large bag or bring extra supplies, because fecal output may increase with expansion of intestinal gas during flight. Because gas expands in flight, water should be substituted for air in devices secured by air-filled cuffs or balloons, such as feeding tubes and urinary catheters.
People who wear contact lenses may want to wear eyeglasses en route or wet their lenses frequently with artificial tears to compensate for low humidity in the airplane. Artificial tears also may be helpful for people with dry eyes. In general, bringing an extra set of eyeglasses or lenses, or a prescription in case replacements are necessary, is a good idea. Extra batteries for hearing aids also may be useful.
Travelers with serious mental health disorders, such as poorly controlled schizophrenia, may pose a risk to themselves or others and should be accompanied by a responsible attendant. Sedating drugs may be recommended also.
Most airlines provide disabled travelers with wheelchairs and stretchers on commercial flights. Some airlines accommodate travelers who need special equipment, such as intravenous lines or ventilators, as long as trained personnel accompany them and arrangements have been made in advance.
General advice about traveling with various medical conditions can be obtained from the medical departments of major airlines, from the Federal Aviation Administration (www.faa.gov), from online travel information sources (see Resources for Help and Information), or from local travel clinics.
Last full review/revision February 2009 by Christopher Sanford, MD, MPH
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