Can You Fly With Interstitial Lung Disease and Oxygen?

Many people with stable interstitial lung disease (ILD) can fly safely, even if they require supplemental oxygen. However, if you have a recent exacerbation, untreated pneumothorax, or unstable pulmonary hypertension, your care team may advise you to postpone travel. For those who are stable, air travel is a major logistical undertaking that requires careful medical preparation. You will need to obtain an individualized assessment from your doctor, complete specific airline forms, and travel with an airline-approved Portable Oxygen Concentrator (POC) with sufficient battery life.

Medical Assessment and Testing

Before booking a flight, you must consult your pulmonologist. Because airplane cabins are pressurized to a lower level than sea level, the available oxygen is reduced. This means you might need supplemental oxygen during a flight even if you do not use it at home ^[1].

Based on your resting oxygen levels, exercise capacity, and disease stability, your care team will decide if you need a High Altitude Simulation Test (HAST), also known as a Hypoxic Challenge Test ^[1][2]. A HAST simulates the lower oxygen levels of an aircraft cabin to estimate whether you need in-flight oxygen and what approximate setting is required ^[1]. Because pre-flight algorithms cannot perfectly predict your needs, this test can be especially useful for long-haul flights or if you have complications like pulmonary hypertension ^[1][3].

Portable Oxygen Concentrators (POCs)

Most airlines do not provide medical oxygen for passengers and prohibit traditional compressed oxygen cylinders on board. Therefore, you will generally need to rent or bring a POC — a medical device that filters nitrogen from the air to provide concentrated oxygen.

When planning your oxygen equipment:

• Use a medical-grade device: Ensure your POC is an FDA-cleared prescription device approved for airline travel. Many over-the-counter devices do not deliver enough oxygen for medical needs ^[4][5].
• Pulse-dose vs. Continuous: Be aware that pulse-dose settings on a POC are not equivalent to liters per minute of continuous flow. Your doctor must prescribe the exact device and setting. Do not change devices or settings on your own ^[6][7].
• Verify performance: A POC’s performance can change based on cabin altitude, the oxygen setting, and whether it uses continuous or pulsed flow ^[8]. Ensure your specific model meets your needs during rest, exertion (like walking through the airport), and sleep.

Airline Rules and Battery Logistics

Every airline has specific rules. You must contact every carrier on your itinerary to understand their notification deadlines, medical clearance forms, and permitted device lists.

A critical step is planning your battery supply. While many airlines require you to carry enough battery power to last at least 150% (1.5 times) of your scheduled flight time, this is a common carrier policy rather than a universal rule ^[9][10]. You must calculate your needs based on the specific airline’s policy, and ensure you have additional power for travel to the airport, layovers, and unexpected delays.

• Battery endurance: A POC’s battery drains faster at higher oxygen settings ^[9].
• Transporting batteries: Spare lithium batteries generally must be carried in your carry-on baggage with the terminals protected. Do not rely on aircraft power outlets to run or charge your device during the flight.

When to Seek Help

Contact your care team before travel if you experience worsening breathlessness, fever, or chest pain. During travel, alert the cabin crew immediately if you experience severe breathlessness, confusion, chest pain, or if your equipment fails.