Fit For Air Travel

Airline restrictions on flying

Airlines can refuse to carry passengers if there could be serious consequences to a passenger’s health during flight, or they have medical conditions that may worsen during a flight. Airlines might request medical clearance if there is an indication that you could be suffering from an unstable medical condition.

Travel by air is not normally advisable in the following cases:

• infants less than 48 hours old (longer after premature births)

• women after the 36th week of pregnancy or 32nd week for multiple pregnancy

• those suffering from:

  • angina or chest pain at rest

  • any active infectious disease

  • decompression sickness after diving

  • increased pressure in the brain (due to bleeding, injury or infection)

  • infection of the ears or sinuses

  • recent heart attack

  • recent stroke

  • recent surgery or injury where trapped air or gas may be present in the body (for example abdominal injury, stomach or bowel surgery, injuries of the eyes or face, brain surgery or eye operations)

  • severe long term diseases affecting your breathing

  • breathlessness at rest

  • unresolved pneumothorax (punctured lung)

  • sickle cell anaemia

  • unstable mental health or psychotic illness

The above list is not exhaustive so if you have an underlying medical condition and are unsure if you might be affected by flying, you should always seek advice from your GP in the first instance.

Restrictions and regulations vary between airlines, so if you are in any doubt, you should seek advice from the medical department of the airline well in advance. Most airlines have a medical advisory service, details of which can usually be found on their website.

Consideration of security measures 

Security restrictions on the type of equipment and fluids which can be taken into the aircraft cabin might affect what medical equipment or medication you can bring with you for use during a flight.

• Please see the Travelling with Medicines advice page for further details.

If you have been fitted with any metal devices such as an artificial joint, pacemakers or internal automatic defibrillators, then you should carry a medical alert letter from your doctor and also alert the security staff that you have a medical device fitted before passing through any screening equipment.

Health considerations when flying

High Altitude

High altitude is generally considered to be upwards from 2400 metres (8000 feet). Aircraft cabins are maintained at a pressure approximately equivalent to between 1800-2400 metres and so developing symptoms of altitude sickness is not usual during flights.

If you have a pre-existing respiratory or cardiac medical condition, you might be more likely to experience symptoms during or after a flight. Being aware that any symptoms experienced may be related to the high altitude can be helpful. You should also be aware that dehydration might make your symptoms worse as might strenuous exertion.

If your conditions are severe you should seek specialist advice from a doctor before planning any flights. You may need to request supplementary oxygen supplies for your use during the flight from the airline in advance.

A few airports are situated above 2400 metres, for example, in the Andes and Himalayas. You should be aware that symptoms of acute mountain sickness such as: headache, nausea, breathing difficulty, mental confusion might develop up to 36 hours after your arrival in such destinations.

• For further information on the effects of altitude, see the Altitude and Travel advice page.

Pregnancy

If you are healthy and your pregnancy has been straightforward, then air travel is generally considered safe. However, some pregnant women with underlying risk factors might be at increased risk of complications such as deep vein thrombosis (DVT) from flying. You should always check your fitness to fly with your midwife or obstetrician before departure.

Airlines request a medical certificate from pregnant travellers if travelling after 28 weeks of pregnancy. Most airlines won't allow air travel after 36 weeks for a single pregnancy, and 32 weeks for multiple pregnancies. The medical certificate should detail the estimated delivery date and confirm that your pregnancy is uncomplicated and progressing normally.

You must ensure you have travel insurance which covers both yourself and your unborn baby in the event you give birth unexpectedly during your trip.

• See the Advice for Pregnant Travellers page for more details.

Flying with a disability

The experience of navigating an airport and flying can be frightening, disorientating and physically exhausting if you suffer from a hidden disability (such as autism, dementia, epilepsy or anxiety). Cabin crew are not allowed to assist travellers who are unable to look after their own physical needs (such as using the toilet, assistance with meals or mobility) during a flight. If you have a physical or hidden disability, you should contact your airline well in advance of travel to check what assistance might be available to you at the airport, getting on and off the aircraft and during the flight.

If you use an electric mobility aid such as an electric scooter or wheelchair, you will need to provide your airline with details of your equipment (such as make, model, size or weight) well in advance of your flight to enable the airline to check they can safely load and stow your equipment and undertake a fire risk of electrical equipment. Showing airline crew your equipment’s operating manual may be helpful, especially if they have any issues loading, disassembling or reassembling your equipment into the aircraft hold.

Infectious Diseases

The quality of aircraft cabin air is carefully controlled and research has shown that there is a very low risk of infectious diseases being transmitted on board. However, transmission of infection can occur between passengers who are seated in the same area of an aircraft, usually as a result of a cough or sneeze or by touching surfaces which have been contaminated. The risk is no different from being sat close to someone on other forms of transport such as a bus or train.

An airline can deny boarding of any passenger who looks unwell, especially if they suspect the passenger might be contagious. If you have recently recovered from an infectious disease, but are still showing physical signs of being unwell, for example crusted spots following chicken pox, then you should carry a letter from a GP confirming that you are no longer infectious.

• To reduce the potential risk of passing on infections to others on board an aircraft, you should postpone travel if you are actively unwell, especially if you have a fever, until you have fully recovered.

If someone has already travelled and is then found to have a serious infectious illness (such as measles or COVID-19) which could be a potential risk to other passengers, then contact tracing of passengers will be carried out by local public health authorities.

Coronavirus (COVID-19)

You should not travel if you have experienced recent symptoms of coronavirus (COVID-19) or have been identified as being a close contact of someone who has experienced COVID-19.

You should check the latest country specific advice on the length of time you must self-isolate for after symptoms develop or being identified as a close contact, before deciding on travel.

Further information on reducing your risk of exposure to coronavirus (COVID-19) during travel is available on the COVID-19: Health Considerations for Travel advice page.

Potential in-flight health problems

Dehydration

The circulating air inside aircraft cabins is very dry and can affect the skin, lips, nose and eyes. Using skin moisturisers, saline nasal sprays and lip balms can help reduce discomfort. If contact lenses cause irritation, they should be removed and spectacles used instead.

Alcohol and caffeine containing drinks have a diuretic effect (causing more urine to be produced) which can lead to dehydration. You should try to drink plenty of clear fluids, such as water, during long flights and limit your consumption of alcohol and caffeine.

Deep Vein Thrombosis (DVT)

The cramped conditions and prolonged periods of immobility on a flight can cause pain, stiffness or swelling of the limbs. Prolonged immobility can lead to slow blood flow in your veins which increases your risk of developing a blood clot, known as deep vein thrombosis (DVT). DVTs most commonly form in the legs. Part of the clot may break off and travel to the lungs, causing a pulmonary embolism (PE) which is potentially life threatening.

• See the Deep Vein Thrombosis advice page for further information and advice on reducing your risk of DVT during travel.

Motion sickness

It is uncommon to experience motion sickness during flying unless in the case of severe turbulence. If you are known to suffer from motion sickness in flight, you should try choose a seat in the mid-section of the aircraft, keep motion sickness bags nearby, and avoid alcohol during and for 24 hours before a flight. You may also wish to discuss with your GP medications to manage your symptoms.

Ear nose, throat and dental conditions

It is common to experience a ‘popping’ sensation in your ears during take-off and landing. This is normal and is caused by air escaping from the middle ear and sinuses during the aircraft’s take off. During landing, air needs to flow back into your sinuses and middle ears in order to equalise with the air pressure in the cabin environment. If you experience any discomfort, simple measures such as swallowing, chewing or yawning will usually relieve symptoms. Infants might benefit from using a pacifier during take-off and landing to stimulate swallowing.

If you are suffering from an ear or sinus infection you should discuss this with a doctor prior to flying as you may experience intense pain during take-off and landing, potentially causing trauma.

General dental treatment, such as fillings, are not usually a contra-indication for flying. However, some dental conditions or treatment can result in pockets of trapped gas (for example unfinished root canal treatment, dental decay or abscesses) which may cause pain and discomfort when flying. You should seek advice from your dental practitioner before flying in this instance.

Flying after diving

Flying too soon after diving might lead to you developing complications such as decompression sickness (more commonly called “the bends”). The general rule is to avoid flying until 12 -24 hours after your last dive. If in any doubt, you should seek specialist advice from your diving school before flying.

Fear of Flying

Fear of flying is the third most common phobia (after the fear of snakes and spiders) and occurs in around 10-25% of airline passengers. If you suffer from fear of flying, the following tips might be useful:

• A visit to your doctor prior to travel can provide you with reassurance about your general fitness for air travel.

  • In severe cases, your doctor may be able to refer you for cognitive behavioural therapy in order to learn different ways to overcome your fears.

• Tell the cabin crew. Reassurance about routine aircraft sounds and in flight activities can help reassure you.

• On a flight, try distracting yourself by talking with other passengers, watching a film, listening to music or reading.

A number of airlines run courses aimed at alleviating fear of flying. Some of these are listed here:

• British Airways Flying with Confidence

• Virgin Atlantic Flying without Fear

• Easyjet Fearless Flyer

Air Rage

This term is used to describe psychological, verbal or physical threats or violence occurring on an aircraft. It is of particular concern because of the cramped conditions inside an aircraft and the inevitable involvement of not only the cabin crew but also other passengers. There have been instances where aircraft have had to land prematurely to offload disruptive passengers and legal action taken against those involved.

The main triggers associated with air rage are:

• alcohol and substance misuse (such as intoxication or withdrawal)

• arguments with travel attendants

• crowding

• delays and frustration caused by lack of information

• nicotine withdrawal in heavy smokers may be a contributing factor for which nicotine gum or patches may prove useful.

Jet Lag

Jet lag is the term used for symptoms caused by disruption of the body’s internal clock (which regulates sleep patterns) due to crossing multiple time zones.

Jet lag can affect your sleep, mental performance, mood, ability to concentrate or cause physical symptoms such as nausea and vomiting, bowel habit changes or loss of appetite. Effects of jet lag gradually wear off as the body adapts to the new time zone.

To minimise the effects of jet lag, you can consider the following measures:

• Try to begin adjusting your body clock a few days before travel by going to bed 1-2 hours later if travelling westward, or earlier if travelling eastward.

• If you take regular ‘time specific’ medications (for example antibiotics or insulin), you should speak to a GP to plan an altered schedule for taking your medication which takes time zone differences into consideration.

• On long haul flights, you should exercise regularly, drink plenty of water, avoid large meals, alcohol or caffeine, and try to sleep on the plane during an overnight flight.

• Once at your destination, spend plenty of time outdoors in the natural daylight; and aim to eat meals and go to bed according to local times in order to help you quickly acclimatise.

• If you are tired during the day, try taking a short nap (approximately 20-30 minutes) as this is unlikely to affect your ability to sleep at night.

• Avoid heavy commitments on the first day after travelling. Be prepared for tiredness in the evenings and early waking, which can last up to 5 days or more.

Disclaimer: This information has been developed for educational purposes only. It is not a substitute for professional medical advice. Should you have questions or concerns about any topic described here, please consult your healthcare professional.