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Health in the Air: Common Problems & Ailments
Author: Sascha Segan
Even if you're a low-maintenance globetrotter, needing only the air that
you breathe to feel content and alive, you may find yourself feeling cruddy
and in need of some pampering soon after you board an airplane.
Many travelers experience flu-like symptoms on planes that persist through
the duration of a flight. Mistakenly, they attribute their temporary unwellness
to jet lag, when in fact they may be suffering from dehydration, mild altitude
sickness, or the in-the-air variation of "sick building syndrome."
A National Academy of Sciences study in late 2001 raised concerns about
cabin air quality. Commissioned by two members of Congress, the study noted
that low cabin air pressure and high levels of ozone in cabin air may cause
respiratory difficulties, but that there's no way for passengers to complain
and that there's no national air-quality standard for commercial aircraft.
"Sick Airplane Syndrome"
If you work in a poorly ventilated, highly populated office space, you're
probably familiar with the occupational hazard known as sick building syndrome.
Fewer public places are as prone to this condition as an airplane cabin--where
strangers are packed, elbow-to-elbow, with no access to fresh air, for extended
periods of time.
Cabin air on almost every domestic aircraft is now recycled, which exacerbates
the problem. For years, airlines pumped fresh air into their aircraft cabins
from outside. At cruising altitude, air temperature is about -65°F,
so the fresh air was pumped through the aircraft's jet engine compressors,
which heated it to about 400°F, then chilled it to comfortable temperatures
by air conditioners and heat exchangers.
In recent years, however, airline executives discovered that they could
curtail fuel expenses and boost profits by mixing 50% fresh air with 50%
filtered, recycled cabin air. In fresh air, the oxygen you inhale contains
under 1% carbon dioxide. The air you exhale, on the other hand, contains
4% carbon dioxide. When many people share a poorly ventilated, enclosed
space for extended periods of time, the carbon dioxide level rises. Carbon
dioxide, as you may know if you work in a poorly ventilated office space,
is the primary culprit in sick building syndrome.
Although recirculated cabin air is usually passed through air filters that
trap allergens, skin flakes, and bacteria, very little new air is being
circulated. About 6 to 10 cubic feet per minute of outside air comes into
the economy-class cabin--as opposed to the legal minimum of 15 to 20 cubic
feet per minute in buildings, and the 50 or more cubic feet per minute the
pilots get in the cockpit. This keeps gases, especially carbon dioxide,
from being ventilated out of the cabin.
In general, the more time you spend in an enclosed, highly populated, poorly
ventilated space like an airplane cabin, the more likely you are to experience
headaches, sluggishness, sore throat, coughing, and dry or watery eyes.
To boot, the air at high altitudes is dryer than the atmosphere above the
Sahara Desert, so you may find your symptoms compounded by dehydration.
Furthermore, evidence suggests that more travelers develop colds in airplane
cabins than in other enclosed, highly populated public spaces. This is partly
because dehydration diminishes the immune system; but it's also because,
as mentioned, few other public spaces keep people in such close quarters
for such an extended period of time.
Fortunately, symptoms of poor cabin air tend to vanish soon after you take
leave of the offending space. Unfortunately, there's not too much you can
do to help yourself. Some suggestions:
- If your budget allows, fly in first or business class, where fewer
people share air space.
- Don't leave home without your inhaler if you have asthma.
- Where possible, try to avoid flying with a cold (see "Flying
with a Cold," below).
- If you're on a connecting flight, try to get as much fresh air
as you can between connections.
- Clear your head with a steaming hot shower when you land.
- Avoid smoke-filled bars when you reach your destination or while
you wait for a connecting flight.
Dehydration
While the earth's desert regions have a 20% to 25% humidity level, the cabin
of a plane flying at cruising altitude (35,000 ft./10,500m) has a mere 15%
humidity content. In this arid environment, your skin evaporates as much
as 8 ounces of water per hour. This is why your eyes burn, your lips dry
out, your head hurts, and you feel generally sluggish, light-headed, and
cranky while you're on a plane.
It's absolutely imperative that you drink lots of water before, during,
and after your flight to maintain your body's fluid reserves. Not only will
you feel much better, you'll help ward off a host of other maladies. The
effects of dehydration compromise the immune system, so you're far more
likely to catch the complimentary cold that comes with air travel if you
don't drink enough water. Dehydration will also aggravate the symptoms of
jet lag.
Even if you don't feel thirsty, drink up. Thirst doesn't necessarily precede
the symptoms of dehydration, which can set in without warning. Experts recommend
that you drink at least two 8-ounce glasses just before departure and 1
liter for every hour you spend in the air--in addition to the beverages
you drink with meals.
Pack a travel-size bottle of skin lotion to replenish moisture in your face
and hands during air travel. If you're taking an overnight flight, don't
forget to pack a toothbrush, which will help you at least to feel fresher
and less dry. Before you prepare to land, visit the lavatory and wash your
face and hands, rinsing with cold water.
If you don't want your morning flight to feel like the red-eye, trade your
contact lenses for glasses before you board, to keep your eyes from drying
out, itching, and turning red. If nothing comes between you and your lenses,
you should at least pack some rewetting drops in your carry-on bag.
Pressurization
If you've lived your whole life at sea level, you're likely to feel wobbly
on a long-distance flight. When cruising at their maximum level of 40,000
feet (12,000m), commercial aircraft are pressurized to an equivalent of
8,000 feet (2,400m), according to Judith Murawski, an industrial hygienist
for the Association of Flight Attendants. That means there's only about
three-quarters as much oxygen in the (already somewhat stale) air as there
is at sea level.
The pressure level is built into the design of commercial aircraft, according
to Murawski. Thickening the air beyond existing levels would require a tougher,
heavier skin so the pressure differential doesn't pop the plane like a balloon.
A heavier plane means greater fuel expenses. (The Concorde, which flies
at 60,000 ft./18,000m and is pressurized to a comfortable 6,000 ft./1,800m),
is just that kind of tougher plane--and tickets on the Concorde cost thousands
of dollars.)
The thin air in most planes isn't lethal--millions of people around the
world live at altitudes of 8,000 feet (2,400m) or greater and are quite
healthy. But 8,000 feet (2,400m) is the threshold at which some people begin
to develop mild altitude sickness, otherwise known as Acute Mountain Sickness,
according to Rick Curtis of Princeton University's Outdoor Action Program.
The symptoms of mild Acute Mountain Sickness are headache, dizziness, fatigue,
shortness of breath, loss of appetite, nausea, disturbed sleep, and a general
feeling of malaise.
The thin air on board makes flying an anathema to people with heart and
lung problems.
There's nothing you can do about pressurization levels on board, and it's
ultimately harmless if you're otherwise healthy, but it's also unpleasant.
Pesticides
The cabins of planes traveling to or from certain countries are subject
to spraying with pesticides, a controversial practice that has brought complaints
from the flight attendants' union and class-action lawsuits filed in 2001
by passengers and flight attendants who say that the bug spray made them
sick.
Australia, Fiji, New Zealand, Barbados, Jamaica, and Panama require planes
to be sprayed while empty; India, Grenada, Kiribati, Trinidad and Tobago,
Madagascar, and Uruguay require actual passengers to be sprayed while on
board. The most highly publicized complaints come from passengers and attendants
on United Airlines flights from Los Angeles to Sydney, Australia.
Permethrin, one pesticide used in Australia, has ingredients similar to
those in lice shampoo. It's banned for use in aircraft cabins in the U.S.
because of safety concerns, according to the Association of Flight Attendants.
The World Health Organization and the airlines say that the pesticides are
safe. But they haven't been approved by the U.S. Environmental Protection
Agency for airline use, and 12 U.S. senators wrote letters to the Bush administration
during the summer of 2001 asking that the Department of Transportation force
airlines to halt the spraying. In a letter dated June 11, 2001, Transportation
Secretary Norman Mineta said the government was "preparing a response."
Flying with a Cold
Next to jet lag, the most ordinary health problem to worry about when you
travel by plane is the common cold or flu. During takeoff and landing, even
the healthiest travelers experience slight ear discomfort as pressure in
the inner ear adapts to rapidly shifting air pressure in the plane cabin.
When your mucous membranes are swollen from a cold, the eustachian tube,
which connects the sinus cavity to the inner ear, is congested. There's
very little room for air to reach the inner ear soon enough to avert severe
discomfort--or worse. In the worst instances, you may suffer permanent damage
to your eardrums if inner ear pressure can't match cabin pressure at a healthy
clip.
If your cold is severe, you should consider postponing your flight. If you
simply must fly, however, use a decongestant or nasal spray before takeoff
and landing to minimize pressure buildup. Read the label of your decongestant
carefully and time your preflight dose so that you'll be able to take another
about 1 hour before you're scheduled to land, as sinus and inner-ear pain
tend to be most severe during descent.
When you start to feel pressure build in your ears, you can make them pop
with a "modified Valsalva maneuver." It's very simple: Pinch your
nostrils closed and breathe in deeply. Then breathe out through the nose,
as though you were trying to blow your fingers off your nostrils. Blow out
in short, firm bursts until you feel your ears "pop." Yawning,
drinking liquids, or chewing gum also help to minimize pressure buildup
during takeoff and landing.
Antihistamines are even more effective than decongestants, but they will
also cause drowsiness. If you're driving yourself from the airport to your
destination, it's best to avoid them.
Kids with Colds--It's even more difficult for kids to make their
ears pop during takeoff and landing. The eustachian tube is especially narrow
in children; the passage is even tighter when mucous membranes are swollen.
This can make ascent and descent especially painful--even dangerous--for
a child with congested sinuses. If your little one is suffering from a cold
or the flu, it's best to keep him grounded until he recuperates, if that's
an option. (If you simply must travel with your child as scheduled, give
him or her an oral child's decongestant an hour before ascent and descent
or administer a spray decongestant before and during takeoff and landing.)
"Economy-Class Syndrome"
Rare but potentially lethal, economy-class syndrome is a result of sitting
in cramped conditions for long periods of time. The combination of a sitting
position, inertia, and pressure on leg veins reduces blood flow in the lower
limbs by two-thirds, according to Dr. Luis Navarro, director of New York's
Vein Treatment Center. Stagnant blood in the legs can clot, leading to a
condition known as deep vein thrombosis (DVT). If those clots break off
and move to the lungs, they can cause a fatal pulmonary embolism like the
one that killed British traveler Emma Christofferson in 2000.
Christofferson was flying from Singapore to London--and DVT has most often
been reported in people who've taken flights of 8 hours or more. The elderly,
pregnant women, women taking hormone therapy or birth control, and people
who have recently undergone surgery, have varicose veins, smoke, or have
a history of blood clots are most at risk, according to Dr. Navarro.
Economy-class syndrome isn't exclusive to air travelers. Two million Americans
suffer from DVT each year, according to Dr. Navarro. In a study published
in the medical journal Chest in 1999, French physicians looked at 160 DVT
patients. Only about a quarter had taken long trips recently, and of that
group, most had been on long car journeys rather than in the air.
The syndrome isn't exclusive to economy class, either. Former Vice President
Dan Quayle got DVT in 1994, and his doctors suspected a flight-heavy schedule
was the culprit. (Former vice presidents generally don't ride in coach.)
If one of your feet, ankles, or legs swells or aches for longer than 24
hours after you board a plane, seek medical help immediately--from an emergency
room, if necessary. The standard treatment for DVT is an injection of Heparin,
followed by an oral anticoagulant. This remedy thins the blood and will
dissipate the clot--and possibly save your life.
There's fortunately a simple solution to DVT: Move. Get an aisle seat and
walk around the cabin every 60 to 90 minutes, to shake up the blood in your
legs. Take off your shoes, put your feet up if possible, and don't cross
your legs. Drink lots of water to stay hydrated and avoid caffeine and alcohol,
which dry you out.
The truly worried, obese, pregnant, or elderly should consider wearing compression
stockings, which promote blood flow. They're available at medical supply
stores for around $15. Put them on before your flight, while lying in bed,
and wear them all day.
You can also stimulate blood flow by doing these leg exercises in your seat:
- Flex and point. From a sitting position, raise your feet slightly
off the floor in front of your seat. Flex your left foot while you point
your right. Then switch: point the left and flex the right. Try to perform
10 to 25 repetitions every hour.
- Round the clock. With your legs still elevated slightly, rotate
both your feet outward in a full circle from the ankle--as though they were
hands on a clock, one moving clockwise, the other moving counterclockwise.
Then switch: rotate them inward. Try to perform 10 to 25 repetitions every
hour.
- Stair master. With your left foot on the floor, raise your right
leg a few inches off the floor. Lower it, then raise your left leg to the
same height. Repeat this motion, as though you were climbing a flight of
very low steps. Try to perform 10 to 25 repetitions every hour.
- Seated knee lifts. With your left leg on the floor, raise your
right knee as close to your body as you can comfortably manage. Return your
right foot to the floor and raise your left knee the same way. Return your
left foot to the floor. Try to perform 10 to 25 repetitions every hour.
Flying with an Allergy
For the severely allergic, flying can be Russian roulette. Fortunately,
the airlines are willing to work with passengers--to some extent. Folks
with peanut allergies are protected by a federal regulation requiring three-row,
peanut-free "buffer zones" on request. Most airlines will go a
bit further and remove peanut-based snacks from entire flights at the request
of a passenger with a peanut allergy, although they warn that they can't
control what other passengers bring aboard.
If you need to bring an injector or other medical device, make sure you
have a note from your doctor and the prescription label from the pharmacy.
It's illegal for airport security to take these devices away from you, if
they're properly documented.
Peanut-allergic passengers may also want to book business class, where many
airlines serve almonds rather than peanuts--and where coach-class snack
fumes won't contaminate the air supply.
Airlines are less sympathetic to passengers with pet allergies; instead
of removing pets from the cabin, they'll remove you from the cabin. Animal-allergic
passengers generally have a choice of being reseated away from the pet or
taking a different flight at no charge.
Finally, anyone with any sort of food allergy should avoid airline food.
You don't know what's in it. Bring your own snacks.
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