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Our 6 month granddaughter lives in South-Africa and has CF. Her parents plan a trip to Holland during the month of April. Is flying possible or does it cause problems.
Dear questoner,
Air travel is certainly possible for CF patients but good preparation is necessary and will depend on the disease severity. Most young patients with CF are fit to fly but it is important that your daughter discusses this with the treating physician because he has the medical information needed. Below we discuss all the issues associated with air travel and provide you with published guidelines and studies on potential risks. This long answer should not scare you at all, but we feel it is important to give you the complete scope of what is involved in case of air travel.
In general we can state the following about travelling for patients with CF. The disease severity varies from mild to very severe and the health status of an individual patient can at times change rapidly. Travelling should thus been done in a time of stability, when the treatment is stable and after the patient has consulted his doctor. During air travel one is exposed to a lower atmospheric pressure (cabin pressure) and thus lower oxygen tension. For healthy people or people with mild/moderate lung disease this does not hold any risk because they are able to compensate for the lower oxygen pressure during travel. But patients with severe lung disease or patients who are already hypoxic before travel can experience problems during a flight.
As children under the age of 1 year are more susceptible to hypoxia especially if they already show small airway disease due to CF, it would be important to know if the baby has had problems with the lungs in the past.
So it is important to discuss with the care-team of the child if they recommend a pre-flight testing which simulates the flying situation in order to find out if it leads to a decrease of the patients’ oxygen saturation. However it has to be pointed out, that a pre-flight testing will only be necessary in a minority of cases. In case the test should reveal that oxygen will be needed during the flight or in case the patient has already daily oxygen need because of advanced lung disease, one has to make sure oxygen is available during the flight. Until departure and at arrival oxygen should be supplied by a company specialized in oxygen delivery (patients can rent portable devices). The patient should always check with his flight company what their specific policy is. There's usually a cost involved. But again, this is only an option in selected patients with advanced disease and is never an issue for most CF patients.

Another important aspect especially for young CF-patients is, that the air extracted from outside the plane at high altitude is extremely dry, so that the humidity inside the plane ranges from 10-20%, which can dehydrate airway secretions. Therefore, one has to make sure, that a baby gets extra fluid intake during a flight in order to avoid dehydration as far as possible.
Furthermore, it would be of importance to get in contact with the airline in advance about safety issues for babies to fly, how they can travel safe and be restrained as normally the airlines do not supply an approved child restrained system from children under 2 years of age.
Long intercontinal flights represent as well a radiation exposure for all passengers
There is another practical aspect. Patients with CF have a complex treatment that should not be discontinued. Drugs and equipment such as aerosols, syringes, etc. should travel with the patient. Moreover we advise that these should be taken on as carry-on luggage so that they will not get lost. Usually a letter of the treating physician is necessary to alow the patient to do so. Some medication needs cold storage. Patient should check the voltage in the country of destination and take an adapter along if needed. Patients with CF need chest physiotherapy and in case they need the help of a physiotherapist they should make arrangements beforehand. Lastly preparing for travel means checking whether you need extra vaccinations.
If travel abroad is well prepared problems can be avoided. So there are many aspects that have to be taken into account, before making a decision to travel by plane with a 6-months old CF-patient.
Kind regards
Dr. A. Malfroot and Dr. D. d'Alquen

-Barrett and Molloy: Arch Dis Child 2009 94: 562 "Do we neglect infant safety during air travel?"
-Bossley and Balfour-Lynn: Arch Dis Child 2008 93: 528-533 "Taking young children on aeroplanes: what are the risks?"
-BTS statement: Managing passengers with respiratory disease planning air travel: British Thoracic Society recommendations, Thorax 2010