It has been written that traveling with oxygen is difficult; what an understatement. A recent airline trip with Marty (my friend and traveling buddy) illustrates the challenges of traveling with oxygen.

Last December, Marty and I decided to go to Washington, DC, for the first US chronic obstructive pulmonary disease (COPD) coalition meeting. Marty has COPD and receives 24-hour oxygen therapy.

This meeting was the first of its kind to bring together multiple individuals representing, treating, or living with COPD. For Marty, it was an opportunity to raise COPD awareness and address issues to improve access to and quality of care. Marty had traveled with oxygen before and he knew the challenges. He thought that if a respiratory therapist flew with him this time, things might go smoothly. That did not happen.

Arrangements were made with Marty’s home care provider to have oxygen available for use at the airport and prior to boarding the plane. The HME provider’s policy was to have an “e” cylinder at the airport and pick up the cylinder after Marty boarded the plane. The charge was $100 for each segment, including the arriving and departing leg in Washington. That is $400 for the use of the cylinders at both airports.

Labor costs are high even if oxygen cylinders are relatively inexpensive. The home care company was going to drop off the e cylinder during a regular liquid oxygen (LOX) refill, so no additional labor was required. Additional arrangements were made to have oxygen at the airports.

The airline charges $100 for each segment of the flight. Since we were able to get direct flights, the charge for oxygen on the plane was $200. Arrangements went smoothly, and all Marty needed to do at the airport was show his prescription.

The ticket to Washington was $360. Supplemental oxygen on the plane would cost $200. The assessed charge from the home care company was $400. The lack of hassle was priceless.

The Trip Begins
We arrived at the airport early with a friend who took Marty’s oxygen back home once he boarded the plane, saving $400. At check-in, we showed the prescription, tickets were issued, and bags were checked. Our first roadblock came when we asked if we could check an empty portable LOX system as baggage so Marty could use it in Washington. The gate agent checked her computer for guidance, but found nothing. She called her supervisor, who looked at the LOX system and seemed confused. The supervisor called a Transportation Security Administration (TSA) agent and the confusion only continued. Finally, the supervisor asked if this unit had ever had oxygen in it. We said no and the LOX portable was finally approved and checked as baggage.

The next hurdle was security. We walked up to the screening area and pointed out that Marty had oxygen. The TSA agent courteously walked Marty to a screening area, waved the magic wand, and allowed Marty to pass (with his LOX portable) and go to the gate. I asked the TSA agent if there was a written policy for oxygen patients to pass through security and he said no. Marty has had a different experience every time he travels by plane and we were just lucky this time. In one past experience, airport security people removed his oxygen and Marty had to breathe room air while waiting for the plane.

When we finally boarded the plane, the oxygen was waiting in Marty’s seat in an aluminum case with a green twist lock indicating the unit was full. The flight attendant did not know how to hook up the oxygen and an oxygen mask was sitting on the case. The RT traveling buddy took the initiative and earned his keep by connecting the cannula and setting the flow. We were going to use Marty’s cannula, but the regulator had a leur-lock connection so we needed to use the cannula that was supplied.

The plane left the gate, but it was a cold November in Minnesota and we needed to deice—an unexpected delay. The number of cylinders the airline provides is based on the travel time and liter flow, and I don’t think delays are added into the calculation. The flight to Washington takes 2 hours, but an hour passed and we were still on the ground. Just when the RT started to worry, we took off.

Search for the Shuttle
Marty arrived at the Washington airport, but the oxygen did not. The COPD conference had made arrangements to provide oxygen for arriving patients, but something had gone wrong. After some frantic and loud conversations with the company responsible for the airport oxygen, we found out that the home care company had given an e cylinder to the hotel shuttle driver to bring to the airport. A shuttle driver delivering oxygen?

Marty practiced his purse-lip breathing as the RT again helped the situation. Running outside to search for a hotel shuttle carrying oxygen would have been funny if it were not so sad. The hotel shuttle driver, who spoke very little English, did not know what he had in the back or what to do with it. Marty survived and we got him on the oxygen and on his way to the conference.

This was a major COPD conference with top physicians in pulmonary medicine, associations representing specialties in respiratory care, large HME providers, manufacturers of respiratory products, and COPD patients. Almost all of the attending oxygen patients had a story about the difficulty in traveling to this conference and arranging oxygen along the way.

In theory, the COPD conference was about patients that have the disease. Experts and industry leaders were there to encourage more research, better diagnostic procedures, and better therapy to live with the disease. It was all about the patients, or was it? There were 30 oxygen patients at the meeting. Many of them had the same traveling problems as Marty. Oxygen was available at the hotel for the patients to refill their LOX portables, yet it was stored on the ninth floor of the hotel. There was no oxygen in the meeting rooms or at the banquet for refilling portables or even an option for stationary oxygen use to conserve portables.

At the meeting, patients presented posters on living with their disease. There were many physicians and clinicians, but few attended the poster presentations. Many of the COPD patients were visibly short of breath due to the need to move to different lectures and the distance between meeting rooms. The top physicians in pulmonary medicine were at this meeting, but I did not see many asking patients if they could help. There was a lot of networking going on between pulmonary clinicians, yet there were patients in need who did not get the benefit of their expertise. Was it really all about the patients?

Empty tank
When we set off to the airport for the return trip, we had a positive attitude. It was bound to be better than the trip to Washington. Wrong again. We checked in without incident and cleared security. We went to the gate and waited for the plane. So far so good. We boarded the plane and there were two aluminum cases with cylinders for the return trip. Flying against the jet stream would take more time to return, so another cylinder was required.

The temperature in Washington was warmer than Minnesota so deicing was not necessary, but another issue came up. We were in a heavy plane that required a longer runway. Due to a ban on flying over the White House, we needed to wait for the only runway available for our type of plane. This was a longer delay than deicing. No problem, we had two cylinders.

We took off and flew for 2 hours. With 30 minutes left in the flight, the first tank was getting low. We opened the second case, broke the security lock, and removed an empty cylinder. Empty!? How can there be a security lock on an empty tank?

We drained the last drop out of the first tank and arrived at the gate with zero pressure in the gauge. Marty survived again in spite of all the obstacles. He is determined to live a normal life no matter how hard our society tries to prevent him.

Marty is one of the many pioneers that are willing to go into the hostile environment of airline travel with oxygen. It is not difficult to improve oxygen access and availability for airline travel, and there is progress with portable concentrators soon being available for in-flight use. We need to help our patients use oxygen wherever they want to go and eventually make long-term oxygen therapy as transparent as wheelchairs and Seeing Eye dogs.

Robert McCoy, BS, RRT, is managing director of Valley Inspired Products Inc, Apple Valley, Minn. McCoy can be reached via email: bmccoy@inspiredrc.com.

Respiratory Insider

Rob DuPuis For many years, firefighters and rescue workers around the world have used carbon composite cylinders for breathing air, according to Rob DuPuis, medical market manager for Luxfer Gas Cylinders, Riverside, Calif. In Japan and Europe, he says, the lightweight composite cylinders are used for oxygen therapy, and in Europe, gas suppliers are offering them filled to 4,350 psi to provide patients with longer ambulatory time. Dealer/Provider spoke with Dupuis about why he believes the US medical market is evolving toward this type of cylinder design. Why would a provider want to carry carbon composite cylinders, which are more expensive than steel or aluminum cylinders? Luxfer carbon composite cylinders are 70% lighter than steel cylinders and 50% lighter than aluminum cylinders. Carbon composite cylinders offer significant clinical benefits and enhance patient lifestyle by providing personal freedom for oxygen users. Most physicians encourage ambulation, and oxygen-system weight is an important factor in a patient’s ability to stay active and lead a healthier, more productive life. Not only are carbon composite cylinders lighter in weight and more compact than steel or aluminum cylinders, when filled to 3,000 psi (a growing trend), carbon composite cylinders hold up to 50% more oxygen within the same physical dimensions—which means much more ambulation time. More and more physicians are recommending these cylinders, the lightest, easiest-to-carry package available. So, providers can increase referrals and differentiate their companies by offering Luxfer carbon composites. Luxfer carbon composite cylinders also offer a retail sales opportunity for providers with a showroom. When patients feel how light and compact the cylinders are, they usually want them, and research has shown that many people are willing to pay more for products that truly improve their quality of life. For better and lighter equipment, why should a provider not just offer liquid oxygen (LOX) systems? Luxfer carbon composite cylinders offer many significant advantages over LOX. Compared to expensive LOX systems, carbon composite cylinders are less costly to begin with and more economical over time, so providers recoup their initial investment more quickly and achieve higher profits. Carbon composite cylinders do not require new and expensive LOX storage and delivery equipment. Unlike LOX systems, carbon composite cylinders do not vent, so the oxygen supply remains in storage when not used. A carbon composite cylinder package is lighter than a comparable LOX package and easier for patients to carry. Carbon composite cylinders provide more flexibility. Multiple cylinders can easily be transported with the user, enabling more hours of ambulation. Carbon composite cylinders are provided ready to use—no filling is required by the oxygen user. They also eliminate the risk of burns and skin irritation associated with liquid oxygen systems. Since they can be used with or without a conserving device, they provide a continuous-flow option. Many LOX units—including the most popular one—offer only a conserving mode. Carbon composite cylinders have a backup in case there is a malfunction while LOX does not provide a backup unit.