Air travel and health problems

International travel will be doubled as projected by international Civil Aviation Organisation (ICAO) by 2020. A survey report by world trade organisation in 2006 showed that out of 840 million passenger more than 50% were on leisure trip, 17% business while 27% to meet friends while others non specific. Such a huge bulk of people, being transported across boards is causing a lot of health hazards.

There are many factors which augment such health problems and include long hours of travel, stress, unfamiliarity to new destinations and unawareness to precautionary measures. Some non-human causes are varying atmospheric pressure vs. Cabin pressure, (which is lower at cruising height (35-42000 ft) than sea level). Moreover cosmic radiations in space, ozone and crossing of time zones are other contributing factors. Due to all above stimuli, air travel may not be so pleasant as fancied, so “welcome onboard” may sound, “unwelcome aboard”!

Following is a brief of some important health hazards related mostly to air travel:

POP-UP-EARS: “I Fell my ear blocked”. “Tingle in ears” “popping-up of drums” are expressions of a lot of passengers. As the aircraft rises, the gases inside ear cavity expand and escape thus pressing ear drum — giving a stretch — sensation in the ear. It is sometimes very painful and may need a doc on board.

Relief may be obtained by chewing a gum, water swallowing, yawning or by expiration against a pinched nose and closed lips (Valsalva Manoeuvre).

DRYNESS OF SKIN: As there is a 20-30% less humidity in crew air cabin, skin may get dry, giving rise to local irritation or even permanent skin disorders. Treatment lies in using some moisturising cream/lotions (though modern security measures at airports do not allow such leisure!)

IRRITATION OF EYES: Nose and even lungs may be provoked due to ozone gas which might enter along with fresh air inside cabin air. However, modern aircrafts are fitted with catalytic converter filters which reduce atmospheric irritants (as in operation theatres). Decongestant eye drops are advised. Washing eyes with clean water also helps.

MOTION SICKNESS: It is by far the most complained off diseases and patients feels nausea, vomiting, dizziness and vertigo. Air turbulence is major causative factor which in turn may disturb Balance — controlling system of ear.

Evidence can be reduced by prior consultation by physician, and avoid sitting in front rows (a matter of prestige by most travellers) A wing-seat may serve the purpose.

JET-LAG: As the plane crosses different time zones, the ‘default’ circarian clock (internal clock) of a person is disturbed, thus causing mental disorientation, confusion, sleeplessness, fatigue and dyschronisation on arrivals. A ‘Rage-Behaviour’ is observed.

To avoid jet-lag, passengers are advised to take a good pre-flight sleep. As Eastwards flights causes less jet-lag and Westwards flights do the opposite, ‘Day time’ flights help in reducing jet-lag. Use of ear-plugs, soft pillows, naps during flight and eye-covers may help reduce the problem. Expose to day-light on arrival also helps.

Medical treatment though include melatonin and zolpiden which is hypnotic but need medical opinion for use.

THE ECONOMY CLASS DILEMMA: Increased travel-flow has caused airlines to take a more commercial stance — they are squeezing the space between seats which forces the passenger to sit in a narrow compressed space. This immobility causes slowed circulation of blood which in turn may trigger clotting (deep venous thrombosis DVT). This will cause swelling, pain and tenderness of legs. Occasionally, a clot may be dislodged and caught inside lungs (pulmonary embolism) leading to sweating, chest pain and even sudden death. A world health organisation (WHO) research by WRIGHT (WHO research into Global Hazards of Travel) has shown that DVT risk doubles after long haul flights (>4-6 hrs).

It is postulated that moving around during flight, feet-moving, leg straightening etc are manoeuvres which can combat DVT. Passengers are strictly advised not to take aspirin to avoid DVT as it may create problems.

COMMUNICABLE DISEASES: Air is being recirculated is around 20-30 circles per hour. Almost 50% air is recycled by recirculation system which trap particles, fungi and bacteria. Diseases such as small pox, influenza, meningitis, SARS (Severe Acute Respiratory Syndrome) and Avian/ Bird Flu and TB are some examples of communicable diseases that can spread thru droplet infections. Though international laws restrict spread through implementing bodies like WHO, WTO (World Trade Organization) and Sanitary and Phytosanitary Measures (SPM). However, to act on guidelines by WHO, (the international health regulations – IHR) has reduced incidence of most of above diseases. However transmission inside aeroplane from one passenger to another is very rare.

The spread of communicable disease is a real threat to global health as the air-load is increasing day by day any pandemic is on the verge if IHR’s are not implemented in soul and spirit. Passengers must get full information about prophylaxis against disease prevalent in countries they are visiting.

PSYCHOLOGICAL PROBLEMS: Mostly patients’ sleep is disturbed, which causes disorientation, and confusion which may be enhanced by un-accustomed atmosphere. Stress is a by-product of travel as air travel involves long-haul flights, broken sleep, new faces (to face!) and other social problems at departures or arrivals. Stress should be combated by a proper planning and in-time packing and keeping all items needed, in tact.

The most frequently faced psychological problem is fear of flying. This may range from hastened heart beat (palpitation), sweating, nervousness to virtually unability to fly. Psychiatrists advice is needed before air-travel. Sensitisation to such condition is needed. Simple re-assurance works miracles. Some anxiolytic drugs also come for rescue but usage of alcohol to ‘stabilize’ nerves is not recommended.

(In this article, medical terms have been avoided or simplified. Any queries may be sent to

— Dr. Irfan Tahir

(Airport Health Officer, Benazir Bhutto International Airport, Islamabad) Courtesy: The News

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