Health Care - Long flights can be bad for health

Air travel is believed to be a risk factor for pulmonary embolism (a clot traveling to the lung). This occurrence has been labeled economy-class syndrome. Immobility aggravated by limited space in economy-class aircraft seating is believed to be partially responsible for this condition.

However, the emphasis on economy class is a mistake, as this condition can occur at any seating level. When passengers sit in their seats for long periods of time, blood flow is restricted, the blood thickens and seat compression may cause injury to the walls of the blood vessels, all of which increase the possibility of the development of a blood clot forming in the legs (deep vein thrombosis, or DVT).

A pulmonary embolism results if a portion of this clot should break free and travel through the veins to the lungs. The result can be pain, fainting and even death. Because symptoms may not appear for up to two weeks or more following a flight, correct diagnosis may be missed and appropriate treatment delayed.

Athletes appear to be particularly vulnerable to this problem, perhaps because they often have bruised or torn muscles which are more prone to clotting.

Research reported in the Sept. 13, 2001, New England Journal of Medicine investigated the relationship of the development of pulmonary embolism (PE) to the duration of air travel among approximately 100 cases over a 30-year period. The incidence of PE was higher among passengers traveling over 3,100 miles, yielding 1.5 cases per million passengers. This incidence increased to 4.8 cases for passengers whose air travel exceeded 6,200 miles. These investigators concluded that air distance traveled, especially over 3,000 miles was a significant contributing risk factor for PE.

An Australian study, reported in the Nov. 8 British Medical Journal, identified a hazard period for the development of a venous thromboembolism during the first two weeks following a long-haul flight (6,200+ miles). This hazard was especially high for travelers who took such a long flight yearly.

Despite this evidence and the fact that approximately 200 lawsuits have been filed against foreign and domestic airlines, there is no consistent policy by airlines to alert passengers to this danger. Some airlines utilize in-flight publications or videos to alert their passengers and further recommend that passengers do exercises while in their seats Other airlines mention the problem on their Web sites but do not mention it to passengers on board. Still other airlines have denied that there is a problem at all.

The American Public Health Association and the Centers for Disease Control launched a DVT Leadership Coalition in February. The objective was to raise awareness among health care workers and the public on how to avoid deep vein thrombosis and the potential for pulmonary embolism.

Improved aircraft technology has allowed for the development of even longer non-stop flights. In February 2004 Singapore Airlines will initiate the longest non-stop flight - 18 hours, 25 minutes - between Los Angeles and Singapore. In August 2004 they will add an 18- hour New York to Singapore flight over the North Pole. Singapore Airlines is developing warnings and advice to passengers at the time of ticket purchase, during the flight, and for two weeks thereafter on how to avoid deep vein thrombosis.

A Web site, www.AirHealth.org, provides advice on how to avoid economy-class syndrome. Among their suggestions are the following:

1. Flex thighs, legs, ankles, and toes frequently-five times or more every 30 minutes.

2. Maintain good hydration-at least one cup of liquid per hour, preferably with a fluid that contains electrolytes, such as Gatorade or Pedialyte. For an 8-hour flight, this means three 20-oz. bottles. Airlines do not provide such liquids, so you must bring your own. However, do not bring powdered drink mixes which must be mixed with water, as airline tapwater is frequently contaminated and should not be drunk.

3. If you are at special risk for developing the condition, such as a history of deep vein thrombosis or recent surgery, wear compression hose. These can be obtained at any medical supply company. They differ from the commonly used elastic support hose, which should be avoided.

4. Consider taking pinokinase (Flite Tabs), a new compound which has been found to prevent blood clotting during air travel.

5. Avoid the following: tight clothing or anything which restricts circulation; crossing your legs for more than a few moments; sleeping, especially for those who are involved in athletic training; and drinking alcohol or caffeine.

Happy Holidays, but fly carefully.

Robert S. Coplan, M.D., M.P.H., has spent a half century studying, practicing, teaching and writing about medicine and issues facing the health care and biotechnology industries.

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