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Asthma and Travel

Asthma symptoms vary greatly, from mild and infrequent to debilitating and severe. The extent of symptoms may influence the type of trip you may choose or the destination. Travellers with more severe asthma may have to consider climate, terrain, air quality and available medical facilities etc. This should be discussed with your Travel Health advisor or Asthma Nurse prior to booking the holiday. Planning ahead is important and the traveller should have their asthma as well controlled as possible before departure. Many asthma sufferers find that their condition improves on holiday but for others it may deteriorate. This may be due to climate change, absence of allergic triggers, stress or exercise/exertion. back to top

Before Departure

Health insurance is essential and you will have to declare that you have been treated for asthma. If travel is within Europe then a European Health Insurance Card can be obtained online. This card allows reciprocal emergency treatment in European countries outwith the UK but would not cover repatriation so insurance cover is still necessary. For those with more severe asthma a covering letter from the GP or Hospital Consultant may be required regarding fitness to travel and general medical condition.

Asthma Review

Most GP practices have their own asthma clinic and travellers could be seen there for review prior to departure. A self management plan can give details of medication, what to do in an emergency and contact numbers for advice. Some travellers with chronic severe or brittle asthma may have to carry a standby course of oral steroids in case of a serious acute attack. Using this would be outlined in the self management plan. Two inhalers should be taken in case of loss or theft, carry them in hand luggage, one in personal hand luggage and the other with travelling companion if possible. Take a printout of all regular prescriptions in case medical advice is required while abroad or medication is lost.

Immunisations

Travellers with asthma can receive the usual immunisations recommended for their particular destination resort unless contraindicated for other reasons. Any recent use of high dose oral steroids should be mentioned if attending for immunisation. Annual influenza immunisation is recommended for those with asthma who require continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission.[1] Pneumococcal immunisation is also reccommended for those with severe asthma who require continuous or frequently repeated use of systemic steroids.[2]

Malaria Prophylaxis

Asthma and its treatment do not usually have any bearing on malaria tablets if required. back to top

Air Travel

Travellers who have well controlled asthma and are fit and well should have no problems with air travel. Those with severe asthma may have difficulties due to reduced air pressure within the cabin. As a guide, if someone can walk for 50 meters at a steady pace without feeling breathless or needing to stop they should be able to cope with the reduced cabin pressure. If they cannot do this then medical advice must be sought before travel. Most people with asthma do not require to take their medication via a nebuliser; for those who do, a standard metered dose inhaler and large volume spacer device is usually an equally effective alternative. For travel purposes a spacer is also much more convenient as they are very portable and can be obtained on prescription from the GP. There are various types of electric nebulisers if they are considered essential: Car battery: plugs into the cigarette lighter in the car. Rechargeable battery: contain their own power supply, can be used anywhere but require charging from the mains supply regularly. Mains 240V: plug into UK mains socket only. Any mains voltage: run on any mains voltage or mains 110/220V, which is useful when travelling to various countries. It is advisable to check the mains voltage at the destination with the travel agent. Permission to use a nebuliser on an aircraft must be sought prior to travel and oxygen can be arranged for air travel if required but has to be confirmed prior to departure and some airlines will charge. Certain airlines will not carry passengers with breathing problems requiring additional oxygen. back to top

Altitude

Activity holidays that include hiking, climbing and skiing in mountainous regions are very popular. People who are unaccustomed to living at high altitude may become unwell with acute mountain sickness even if they are fit and well prior to travel. However if asthma is well controlled, once acclimatised most people should be able to cope at high altitude. Certain conditions do have to be taken into consideration; people whose asthma is triggered by cold may find the drop in air temperature a problem and those who have exercise induced asthma could be affected by the exertion of climbing. The limited data available suggests that asthma is not exacerbated by high altitude although adequate preparation and caution is advised. If house-dust mite is a trigger factor for some, they may find that their asthma improves at high altitude as dust mite cannot survive at this height. Some travellers fly directly into high altitude and do not have time to acclimatise slowly; they should discuss this with their GP when compiling the self management plan. It may be necessary to increase inhaled steroids for a few weeks prior to departure and to monitor peak flow measurements (lung function) whilst away. Aerosol metered dose inhalers may not function properly under freezing conditions and may need to be warmed in the hands before use. For further information on asthma at altitude see Asthma UK. back to top

Physical Activity

Those with well controlled asthma can be as active as desired, according to their own level of fitness. Some may find an increased level of exertion under hot dry conditions a challenge. Scuba diving is not recommended for asthma sufferers and should be avoided. Air pollution particularly in Far Eastern cities may also add to breathing difficulties. Ozone can be problematic for some people, levels are higher on hot summer days and if this is a trigger factor avoid exercising outside in the afternoon. For further information on any aspect of asthma contact the Asthma UK Adviceline on 0800 121 6244 (Mon-Fri 09:00-17:00) and speak to an asthma Nurse Specialist. To order free support literature telephone: 0800 121 6255.
     
     
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