New York Times reporter Jane Brody’s recent article on avoiding the health hazards of air travel, “Flying Healthy, From Takeoff Past Landing,” sparked a lot of interest, and some questions, from readers.
Dr. Mark GendreauThis week, travel health expert Dr. Mark Gendreau answered readers’ questions on safe travel. Dr. Gendreau is senior staff physician and vice chair of emergency medicine at Lahey Clinic in Burlington, Mass., and assistant professor of emergency medicine at the Tufts School of Medicine in Boston. His special interests include health issues associated with commercial air travel, including transmission of infectious diseases.
Do you have additional questions on air travel health? Post your questions in the comments section below. Dr. Gendreau will answer questions in the coming weeks.
Saline Nasal Sprays
I’ve found that saline nasal spray used before, during and after being in planes or crowds wards off respiratory ailments for me. Have you any experience with this? — Susan Skovronek
Your anecdotal experience is supported by science. Several studies have shown that daily use of saline nasal spray can reduce the chance of getting upper respiratory tract infections and sinusitis. Saline sprays are readily available over-the-counter.
The saline spray increases the activity of the nasal cilia, the tiny hairs on the lining of the nasal passages that beat back and forth to remove particles and microorganisms from the nose. The saline also helps moisten the mucous membranes of our eyes, nose and mouth, which serve as our initial barrier of protection against invading microorganisms. Maintaining proper moisture at this level is critical for this immune barrier to function properly.
I also recommend getting into the habit using an alcohol-based hand sanitizer to maintain good hand hygiene whenever you are traveling or out in the public, since most infections that we catch are introduced by our hands touching our eyes, nose or mouth.
Ear Pain and Sinus Congestion
As someone who always seems to get congestion or sinus infections after a flight, I try to hydrate and stay away from caffeine during the flight. I also take a decongestant before take off to relieve pressure in my ears for takeoff and landing. I wonder: would this also contribute to drying of nasal and mucous passages and my sinus problems post-flight?
–Karo M. Serle, Regulatory Analyst, Communications Division, California Public Utilities Commission
Yes, the use of decongestants contributes to the drying of nasal and mucous passages. But they also help relieve the symptoms of pain and difficulty hearing that many people suffer from during descent and landing of
the aircraft. Studies show that decongestants work best when taken 30 minutes prior to landing, rather than taking them before the flight.
Keep in mind that the pressure within the passenger cabin changes during
flight, going from high on takeoff to low during cruising — and back to high on landing. These changes tend to collapse the eustachian tube in the middle ear, resulting in the characteristic “pop”
sensation, pain and difficulty hearing.
People who have nasal allergies or sinusitis are more prone to nasal, ear and sinus problems because they tend to have a blocked or congested eustachian tube or sinuses. This makes it more difficult to equalize the pressures, especially during descent. Continued sinus and ear discomfort or congestion that lasts more than several hours may indicate other problems like chronic sinusitis. If symptoms persist, check with your doctor.
It is always a good idea to stay well hydrated, since the passenger cabin is notorious for having a low humidity that can exacerbate nasal and sinus problems. You might find relief of your symptoms by changing your use of a decongestant to 30 minutes prior to landing, rather than before takeoff. It may also be beneficial to use a saline nasal spray, which studies show reduce the occurrence of sinusitis.
Cosmic Radiation
I am 6 months pregnant and will be taking a trip from Los Angeles to London/Paris next week. Your article about cosmic radiation was a bit alarming. I wanted to know: what are the hazards to pregnant women? – Helen Hong
Cosmic radiation is a form of radiation that comes from outside the solar system, and from particles released during solar flares. The intensity of cosmic radiation depends on the year (due to solar cycles), altitude, latitude and length of exposure.
While fight crews are classified as “radiation workers” due to the fact that they are exposed to higher natural radiation doses compared to the general public, the health risks associated with these higher exposures remain inconclusive, and it is agreed that even the most frequent air travelers have little or no increased health risk from cosmic radiation exposure.
However, pregnant air travelers warrant special consideration, since recent studies show that the fetus is exposed to the same amounts of radiation as the mother, and radiation exposures greater than 2 millisievert (radiation dose is measured in millisievert) have been associated with congenital and cognitive problems.
You have nothing to fear in regard to the radiation exposure you and your baby will have during your trip, since it will equate to a flight time of 10.5 hours each way, or 0.1 millisievert exposure each way. However, pregnant woman should have a radiation exposure limit of no more than 1 millisievert during the whole pregnancy, which equates to approximately 200 flight hours during the pregnancy.
Radiation exposure increases during solar flares, so the Federal Aviation Administration notifies air carriers of impending solar flares. That way they can adjust aircraft altitude and limit the extra radiation exposure during such times. However there have been anecdotal reports of air carriers failing to adjust their flight altitudes during solar flares. Pregnant women and air travelers in general can access the solar-radiation alert system online at the National Weather Service’s Space Weather Prediction Center (www.sec.noaa.gov) before travelling and change flight days accordingly
In-Flight Medical Emergencies
I recently had a heart attack, and just hours after arriving at the hospital had a quadruple bypass open heart surgery. Fortunately I was home, and not traveling for business, when this happened. I’m 51, fairly thin, vegetarian, nonsmoking, nondrinking, and I had what I incorrectly thought was a healthy enough diet.
My question is this: my mind has begun to replay “what if?” scenarios, and I wonder how airlines would deal with a passenger who complained of chest pains, say, one hour into a 5-hour flight. Or a 10-hour or 15-hour flight?
Given that chest pains are sometimes not indicative of heart attack — but sometimes are — what is the passenger’s duty to minimize false alarms while not putting his or her own life at risk? – name withheld on request
Passengers should always notify a flight attendant whenever they are having a health problem. Although the flight crew has only very basic training on responding to medical emergencies, they have the ability to communicate via satellite phones to physicians on the ground, and several telemedical companies routinely assist flight crews during in-flight medical emergencies by providing instructions on what to do. Many times there are medically trained fellow passengers who also readily volunteer to assist whenever the flight crew broadcasts a call for help.
All U.S–based commercial aircraft that carry more than 85 passengers, and most international air carriers, carry an automated external defibrillator, as well as both a basic and enhanced emergency medical kit. Only medical professionals or flight crew instructed by on-ground physicians are allowed access to the enhanced medical kit, which carries various emergency medications to deal with serious in–flight medical emergencies. The captain of the aircraft has the ultimate authority as to whether or not to divert the aircraft, but they tend to side with caution and what is in the best interest of the stricken passenger.
In-flight medical emergencies are increasing, and this is partly due to more people with medical conditions traveling by air. It is very important to note that unique environmental and physiological changes occur as a result of changes in pressure during routine commercial air travel. These changes can exacerbate preexisting medical conditions, such as cardiac and lung conditions.
I recommend that individuals with any cardiac, lung or blood diseases, diabetes or cancer, as well as those who have undergone any surgery within a 14-day period prior to travel, check with their doctor to make sure they are fit for air travel. Children need to be at least 1 week old to safely travel by air. As a rule of thumb ,one should be able to walk a distance of 150 feet and climb one flight of stairs without developing any chest pain or severe shortness of breath.
Jet Lag
I have a question about how jet lag and long-haul flights affect infants, and what might make a long trip easier. I live in Singapore but am hoping to travel back to New York with my wife and our daughter, who will be 5 months old by the time we travel. She’ll have all her immunizations, and our pediatrician suggests giving her decongestant drops.
I’m also wondering what (if anything) to do about jet lag, and what to expect from her once in New York for three weeks – and then back in Singapore. It’s a 24-hour trip, with a layover in Japan and a 12-hour time difference. And since we have immediate family in New York its not really a trip we can avoid. — Mohammed Hadi
Jet lag is a temporary circadian rhythm disorder associated with long-haul flights and is characterized by sleep disturbances, fatigue, constipation and reduced coordination and cognitive skills. It is caused by the desynchronization between the body’s internal clock, which resides in the hypothalamus of the brain, and the new light/dark cycle at the destination.
The degree and severity of jet lag depends on the flight direction and the number of time zones crossed. Westward travel lengthens the traveler’s day, thereby causing a delay in the circadian rhythm. Eastward travel, on the other hand, shortens the day and causes an advance in the circadian rhythm.
Travelers tend to have greater difficulty falling asleep after an eastward travel than after westward travel because of the internal clock’s natural tendency to resist shortening the 24-hour day cycle. Re-synchronization of the internal clock typically takes one and a half days for every time zone crossed eastward and one day for every time zone crossed westward.
Taking melatonin is the best treatment for jet lag symptoms, especially when traveling across five or more time zones. Most individuals find it works best when it is taken when it would be bedtime at the desired destination.
If traveling across more than seven time zones, pretreatment for three days prior to travel may be needed to get the best effect. However, use of melatonin in children under the age of 16 has not been studied, and as a result it should not be given to children. People taking warfarin (coumadin) or who have epilepsy should also not take melatonin.
Other treatment methods have been recommended, such as going to bed one hour earlier than usual, and awakening one hour earlier than usual, beginning three days before traveling eastward. Or, for westbound travel, going to sleep one hour later and awakening one hour later than usual three days before a trip.
Phototherapy, which involves intentional exposure to — or avoidance of — bright light at the destination to hasten resynchronization, has also been advocated. But it is often impractical or inconvenient. Jet lag calculators (www.Jetlag.com) are available to assist travelers figure out a light exposure schedule should they wish to try phototherapy.
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