HEALTHNET

What is economy-class syndrome?

It is found that the chance of having an attack of "thromboembolism" is increased after long haul flights...

(Posted on 8 March 2007)

Q1. What is economy-class syndrome?

A1. It is found that the chance of having an attack of "thromboembolism" is increased after long haul flights. "Thromboembolism" is the blockage of a blood vessel by a clot, which when dislodged, can travel in the bloodstream to the heart, lungs or brain and cause serious damage.

When the association was first discovered in the eighties, many blamed the crowdedness of the economy cabin as the major culprit. It was subsequently found that the condition also occurs in travelers of the business or first class. Other factors, such as personal risk factors, low atmospheric pressure, low oxygen levels, low humidity and dehydration or disturbed circadian rhythm may all contribute in addition to the cramped leg room.

A clot forming in the calf veins may not cause any symptoms. Early warnings may be neglected, since swollen ankles and leg cramps are common during and after long flights. If a clot travels to the lung, it can cause pain in the chest, difficulty in breathing, fainting attacks, and sometimes sudden death. The risk is higher the longer the distance traveled. A report from France published in the New England Journal of Medicine figured the risk to be 0.01 case per million when traveling less than 5000 km. This jumped to 1.5 cases per million when the flight is over 5000 km, and increased further to 4.8 cases per million when traveling more than 10,000 km. The danger is the highest within two weeks after a flight.

Q2. What can I do on the airplane to prevent economy-class syndrome?

A2. Frequent and regular stretching exercises of the lower limbs during flight are simple and effective means to prevent the economy-class syndrome since it is the contractions of the large muscles that keep the blood traveling through the one-way valve systems in the veins. You can take off your shoes to exercise your lower limbs after taking off. Walk around whenever it is safe and convenient to do so. Take every opportunity to change position. One should avoid crossing the legs when seated. Do not take sleeping pills, as this would prevent you from exercising yourself.

Some studies have shown that wearing medical compression stockings may decrease the chance of clot formation in the legs during long flights. These graduated compression stockings have greater compression at the ankles and gradually less and less going up the calf. To be effective, such compression stockings must fit your size and be put on correctly.

Keep yourself warm by wearing loose fitting clothes. Keep yourself well hydrated by drinking plenty of clear fluids. Avoid alcohol and caffeinated drinks, which can aggravate dehydration. If you experience unusual swelling, redness or pain in your calf and thighs after a flight, consult your doctor immediately.

Q3. Can a person take any medicine before departure to prevent it from happening?

A3. Although there are effective drugs against blood clot formation, these should be taken under the advice of medical professionals. People who have high risk of developing blood clots should seek help from health providers in order to take additional measures to prevent the economy-class syndrome before taking long haul flights:

Those with blood disorder affecting clotting tendency
Personal or family history of clotting diseases
Cardiovascular disease
Current or history of cancer
Major surgery within the past 6 weeks
Recent trauma to lower limbs or abdomen
After prolonged immobilization
Pregnancy

To complicate the clinical picture, an individual may have several risk factors interacting. Minor problems such as varicose veins and obesity may also slightly increase the risk of clot formation, as well as tobacco smokers, and people on female hormone treatment such as oral contraceptive pills. The healthcare provider would assess the risk for the individual and recommend the best strategy to cope. Some may prescribe aspirin to be taken before departure. The drug can decrease the function of blood platelets, and prevent them from clumping together to initiate blood clots. High risk patient may need a more potent blood thinning drug given directly into the veins before departure.

Source: Quality HealthCare