Fly Well

Physiological formation flying

October 1, 2010

Dr. Jonathan Sackier October. Falling leaves, crackling fires, perfect flying weather, and healthy lung month. Healthy lung month? What will they dream up next?

Place your hands on your chest, inhale, and experience the physiological equivalent of formation flying. Rib muscles, diaphragm, blood flow, and expanding lungs, all in glorious synchrony. Unless something fails. Which is bad news in formation flying—and breathing.

The lungs contain numerous alveoli, tiny bags surrounded by microscopic blood vessels where inhaled oxygen is transferred into the blood and carbon dioxide moves out. Air reaches the alveoli via multiple-branched bronchi, tubes starting in the neck with the trachea, or windpipe. The airways are moistened with mucus (I have a sneaking suspicion it is 15W50) that also serves to capture sneaky bacteria traveling to their ideal romantic vacation spot—the warm, dark alveoli where they gleefully flourish. Cells lining the airways are equipped with layers of beating cilia, hairs that sweep the bacteria-bearing mucus to the throat where, with sounds resembling a Stearman with a dodgy cylinder, the goop is expelled. Yuck.

Lung problems are especially germane to pilots, for our preferred environment is less oxygen-rich—so we need the best set of bellows possible. Please consider using highly fashionable nasal cannulae or face masks. But avoid cigarettes like the plague. I hope few readers smoke, but those who do, or care about someone who does, stay with me. If you want any confirmation that smoking impairs oxygenation, take a smoker for a flight, noting the altitude they start snoring, which is much lower than you! (Seriously, though, don’t do this—it’s not nice having a snorer dislodging the headliner.)

King James I of England rightly said, “Smoking is hateful to the nose, harmful to the brain, and dangerous to the lungs.” Everyone knows that cigarettes (and cigars and pipes) cause lung cancer and heart disease, but smoking also impairs lung function, paralyzing the cilia, which allow the bronchi and alveoli mucus to become infected. It also allows the development of emphysema, a rotten disease that effectively diminishes the surface area available for gas exchange, causing chronic breathlessness, coughing, and threat to your aviation medical. Returning to lung cancer, it is sobering that despite much progress treating many cancers, this continues to daunt us. Don’t smoke, counsel everyone you know not to smoke, and avoid smoky environments.

Learn more

Dr. Jonathan Sackier will be a featured speaker at AOPA Aviation Summit November 11 through 13 in Long Beach, California. Visit the website.

Asthma is a common breathing disorder—often presenting in youth, although anyone can develop this problem at any age. Allergens irritate the airways, and cause constriction, thereby reducing alveolar airflow. Asthmatics limit attacks with medications and use other drugs, often inhaled, to fend off an acute attack.

If bacteria does settle in the lung mucus, the body mounts a response, sending in the troops—white blood cells that muscle their way out of blood vessels. In James Bond movies there is the inevitable scene where a villain falls into a shark-infested pool, turning the turbulent water red. Imagine a similar almighty, but microscopic, battle between bugs and white cells, where the resultant color change is to green, not red. The walls of the lung become inflamed and the goop is coughed up. This infection is known as bronchitis when affecting the air tubes and pneumonia when deeper in the lungs. Obviously, if you are feeling sick you are not going flying—bronchitis or pneumonia induces fever and your whole body feels like a war zone. Give yourself plenty of time after you recover from such an illness; lingering lung inflammation may be sufficient to reduce your ability to absorb oxygen, which could endanger you and your passengers.

Just as you carefully review the weather, charts, aircraft, and your own fitness to fly, spare a thought for your passengers. The preflight briefing obviously includes dealing with emergencies, avoiding hyperventilation, and where to find the airsickness bags, but should also cover personal medical health. Prior to considering a flight, ask your passengers if they have any health issues, with special emphasis on those that could impact everyone’s safety in the air—so ascertain if they are smokers, have asthma, or other lung or heart disease. Ensure that any medications your fellow aviators may need are on board and accessible and be prepared to abort the flight if a medical emergency develops.

Every pilot knows about the aeromedical risk of carbon monoxide poisoning; having a detector on board and rehearsing the steps to take in the event of a positive indication is critical. However, in the presence of preexisting lung disease one’s tolerance for this deadly gas is lower. If you, or a passenger, have a lung (or cardiac) issue, bear this in mind.

Check online to learn more and consider what Robert Orben, magician and comedian stated: “There’s so much pollution in the air now that if it weren’t for our lungs there’d be no place to put it all.”

Jonathan M. Sackier has practiced medicine in the United States for the past 20 years. E-mail the author at jonathan.sackier@aopa.org.