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Travel can be stressful. For individuals with pulmonary hypertension, there are several important factors to be considered, especially when flying. Preparing in advance for your trip will make your holiday travel more enjoyable. Below are some tips and information that will make planning your trip, and travelling, a little more comfortable.
A Preflight Checklist
Talk to your doctor to see if any pre-flight testing may be warranted to assure that your condition is stable enough for travel
Carry a letter from your doctor to show Security and Customs Officials, if needed, that provides not only a medical history but also provides a list of the medications you are taking/carrying with you
Carry adequate supplies of prescribed medicine in your
Carry your emergency contact phone numbers with you at all times, these should include a list of your doctors (including your PH specialist) and next of kin
During the flight, consider wearing compression stockings, pass on the alcohol, exercise your legs and feet every chance you can to avoid blood clots
If you are travelling by air, you can order special meals such as low-sodium, low fat, and diabetic, assuming meals are being served on your flights. Special meals must be ordered at least 24 hours before each flight
Order a wheelchair for the airports. This can be done at any time. If you are going to an unfamiliar airport, it is especially important because the walks can be very long. Security, Immigration and Customs lines are often quite long and slow. If you are in a wheelchair, you can handle such lines much faster and with less stress.
Ask your PH coordinator to help you locate the closest PH centre to where you will be staying, in case you have an emergency during your trip.
Before deciding whether you need trip cancellation insurance and how much, figure out how much of your trip's cost would be non-refundable if you had to cancel
The risk of contracting a contagious illness is heightened when we travel within any enclosed space, especially during the winter months; when most respiratory viruses thrive:
sanitize your hands often.
The Need for Oxygen
Travelling to high altitude cities as well as air travel itself poses a significant concern because hypoxia (oxygen depletion) at high altitude will trigger the narrowing of pulmonary blood vessels and cause further increases in pulmonary artery pressure. This may rapidly worsen how you feel. Planning this type of trip always requires a conversation with your PH doctor and while you may be given the ok to travel to a high altitude city and or in a plane, you may require a careful pre-trip assessment, including high altitude simulation testing to assess low oxygen conditions. If travel is necessary or strongly desired, you will most likely be required to use supplemental oxygen.
An important first step when given the green light by your doctor is to contact the airline you plan to be flying on to determine their policies on portable oxygen for travellers suffering from pulmonary hypertension.
Different airlines have different rules about oxygen. The rules can differ depending on where you are flying.
The following is adapted from the
Canadian Lung Association
Air Canada rules about medical oxygen
Portable oxygen concentrators (POCs): Air Canada allows POCs on all flights.
Oxygen tank rental: Air Canada allows you to rent oxygen tanks through a third party supplier. They charge $17 per flight. They give you the oxygen once you are seated on the plane. They do not supply oxygen to use while you are in the airport or while you are on stopovers (transferring planes, etc.). You must arrange your own supply of oxygen for all the time you will spend in airports, going through security, etc. You need to order the oxygen 48 hours in advance and get medical approval for travel.
To rent oxygen equipment or to use a POC, you need to make arrangements with Air Canada at least 48 hours in advance. Your doctor must complete a medical form and fax it to Air Canada. Visit the
Air Canada website
to find out how to get medical approval for travel on Air Canada, and links to the form for your doctor to fill out. For more information and updates on Air Canada rules about medical oxygen, call 1-888-247-2262.
WestJet rules about medical oxygen
Portable oxygen concentrators (POCs): WestJet allows POCs on all flights. You must use a model of POC that’s on their list of approved models, and follow other rules. You must also have a signed physician statement.
Bringing your own oxygen tanks: WestJet allows passengers to bring their own oxygen aboard flights in Canada (domestic flights only), if they meet certain conditions. WestJet will permit up to two guests with up to two oxygen cylinders each for personal use onboard the aircraft. Visit the
to find out more about WestJet regulations regarding oxygen.
For more information on travelling with oxygen on WestJet, call 1-888-937-8538 or visit
WestJet’s webpage on travelling with special medical needs
Travel to the USA and other countries
If you plan to travel outside of Canada, talk to your local oxygen provider and ask for help to plan oxygen for your entire trip.
3 Ways to get Medical Oxygen when you Fly
In general, there are 3 possible ways to get medical oxygen while you fly:
The airline lets you bring your own oxygen tank with gaseous oxygen.
The airline lets you rent oxygen equipment from them.
The airline lets you carry a portable oxygen concentrator (POC)
1. If you are supplying your own oxygen:
Make sure your oxygen tank(s) is approved by your airline. Ask your oxygen supply company to look at your oxygen prescription, your travel plans and calculate how much oxygen you will need.
When figuring out how much oxygen you will need, your oxygen supplier will have to consider:
The oxygen rate you are prescribed (you may use a higher rate when you are in the air)
The time it will take to get through airport security areas
Time in the air
Time on the runways, taxiing
Time in airports between flights, if you have a stopover
Possible flight delays
Ask your oxygen supplier to make sure you have an oxygen supply waiting for you once you reach your destination. If your supplier doesn’t supply oxygen at your destination, they may be able to tell you about a company that does.
Make sure you bring:
Your nasal cannula
Your written prescription for oxygen
A physician’s statement, if your airline requires it
Contact information for the oxygen supply company in your hometown and in the place you are visiting.
2. If you plan to use the airline’s oxygen supplier, talk with this company. The airline will give you their contact information.
Tell them how much oxygen you need (your doctor or respiratory therapist has told you).
Make sure they will supply oxygen from the moment you arrive at the airport until you get to your destination – this must include time to go through security checks, time in the air, stopover time, plus any possible delays.
If they do not supply oxygen from the time you arrive in your departure airport until the time you clear customs in your destination, you must arrange for a separate oxygen supply for use in your departure airport, any stopover airports, and your arrival airport.
Make sure you know how to use the oxygen tank they will supply.
Bring your written oxygen prescription and a physician statement, if required.
Ask if you need to bring nasal cannula.
3. If the airline lets you carry a portable oxygen concentrator (POC):
Portable oxygen concentrators (also called portable concentrators or POCs) are similar to home oxygen concentrators, but they're smaller and easy to carry. Portable oxygen concentrators supply you with a higher amount of oxygen than what’s found in the air around you. With a POC, you don’t actually carry around a tank of oxygen. Instead, the POC draws oxygen from the air around you, concentrates it (builds it up), and then sends you the oxygen-enriched air.
If your airline allows POCs, you are responsible for bringing your own. You can buy a portable oxygen concentrator or rent one from an oxygen or medical supply company. The airline does not charge you for bringing the portable oxygen concentrator, but it will ask you to follow certain rules and bring a signed note from your doctor saying you are fit and able to use the POC. WestJet and Air Canada allow portable oxygen concentrators on domestic flights and international fights. Many U.S. airlines also allow you to carry portable oxygen concentrators.
Always prepare for the unexpected such as delays or unplanned layovers. What will you do for oxygen if your trip is longer than expected? Will the battery life for your equipment last long enough, and how will you recharge batteries, if you have cancellations or unexpected delays. If you plan things in advance, you’ll have enough oxygen to stay safe and healthy.
Before you book any flights, learn about the rules for oxygen on that particular flight on that particular airline. Allow at least a few days to talk with the airline and let them know that you require oxygen on a particular flight. Don’t book your flight until you have arranged your oxygen supply.
When you talk with the airline about medical oxygen, tell them your planned destination and ask:
What are your rules about using medical oxygen? Can you show me a written policy?
Can I bring my own oxygen tank? If so, what are the rules?
Do you supply medical oxygen? If so, what is the cost?
Do you allow me to carry a portable oxygen concentrator (POC)? If so, what are the rules? What sizes and brands are allowed?
Can I bring oxygen tanks? How many tanks can I bring?
Do I need a physician's (doctor’s) statement proving my medical need for this device?
Will you provide emergency oxygen if I need it?
How much advance notice do I need to give you that I require oxygen?
What's your company policy on batteries in carry-on luggage?
Can I bring other medical devices, like a humidifier?
What is the security procedure for medical oxygen?
What is the airport procedure for medical oxygen?
Staying low sodium while travelling
Avoid snacks that are pre-packaged, as many are high in sodium. Whole fruit and unsalted nuts are a great snack during the day.
Read Nutrition Labels:
If you need to purchase pre-packaged foods, read nutrition labels to understand their sodium content. First, look at the ingredient list. MSG, baking soda, baking powder, disodium phosphate, sodium alginate, and sodium nitrate all represent sodium. Secondly, look at the sodium percentage on the Nutrition Facts label. Choose foods that represent less than 10% of your daily value of sodium.
General Sodium Tips:
Ordering at Restaurants:
Ask a lot of questions to understand how food is prepared. Ask about spices, rubs, marinades, dressings and finishing sauces. All of these can be high in sodium.
Avoid Foods Naturally High in Salt:
Avoiding foods such as cheese, olives, pickles, cured or smoked meats and deli meat will help to keep sodium intake down.
Keep it Simple:
The more complicated a dish, the more likely the sodium content is high. Avoid casseroles, “pot pies” and other dishes that have a lot of “mystery” ingredients. Instead, opt for entrees that are grilled, baked, or roasted. When it comes to side dishes, choose fruits and vegetables that are prepared simply, such as steamed vegetables with no sauce. Ask for lemon to season vegetables (it is great on steamed broccoli!).
When dining out, look for locally owned restaurants. More likely than not, food is prepared to order which may make it easier for them to accommodate low sodium requests.
Dressings, Sauces and Condiments:
All of these are high in sodium. To eat well, ask for any and all sauces to be served on the side and lightly dip your fork into the sauce before spearing your food. Also, steak, teriyaki and barbecue sauces, as well as ketchup, are high in sugar, sodium and calories. If you use them, do so sparingly.
Remember to limit fluid intake (1.5 liters-2 litres of ALL fluids per day) if you happen to suffer from fluid retention.
Travelling with Remodulin/Flolan
Inform your clinic/nurse/pharmacy/CCAC of any and all travel plans whether it is 1 day or 30 days. Discuss your travel plans as early as you can. The specialty pharmacy will need to know where supplies will be shipped for you and for how many days.
Keeping Flolan cold is a big factor if taking a long trip. Airlines, restaurants and hotels will keep ice packs in their refrigerator, freezer for you. Hotels will supply a refrigerator with the small freezer section.
Consider purchasing a small backpack on wheels to carry your pump, 2 days (discuss number of days with your PH team) of supplies, letters (indicating supplies needed to carry on the plane) and other things needed for trip. Other patients, who are seasoned travellers, recommend carrying a small thermos/cooler for ice and the medication cassette: small lunch bag ice packs last for about 6 hours.
Shoppers Drug Mart also suggests taking a 3rd pump as a backup. Patient and clinics will need to discuss taking a 3rd pump with CCAC if they are involved with paying for the supplies and pump rentals.
WestJet’s Companion Fare Program – apply for free companion seating
Westjet may provide seating
at no charge
for the companion or caregiver of a PH patient. In order to apply for this special additional seating, all you need to do is fill out the application form with your doctor. PHA Canada member Dianne Gale can vouch for Westjet's incredible companion seating:
"When we travelled to Toronto (for surgery), we used WestJet. I applied & received a companion fare: WestJet gives them to individuals who cannot travel alone. I got it because I couldn't manage my oxygen by myself. Alf went for free, so we just paid for my flight each way. WestJet gives you a number, and once you have been approved, you use that number whenever you book. They granted me companion seat privileges permanently."
Learn more and apply for Westjet's free companion seating here
Easter Seals – Caregiver Resources and disability travel card
Easter Seals also offers many services and supports for caregivers.
They also offer a disability travel card: this Disability Travel Card is intended for people with disabilities who require the assitance of a support person when traveling. The Card offers it’s holder discounts to the support person in attendance with them when traveling with participating partners Via Rail, Greyhound bus lines and Coach Canada.
Learn more about these resources on their web page.
Surviving Cold Weather