Travelling With CF
Whether for business or pleasure, travelling can be exciting but it is important to be prepared. The following tips will help ensure your trip goes as smoothly as possible.
If you are worried about becoming sick while you are away, we can provide prescriptions for antibiotics and the names of CF centres in the area(s) where you are travelling. Please keep their contact information and directions in hand.
Be sure to seek country-specific medical advice from a travel clinic to ensure all of your necessary vaccines are received. Transplant recipients should not receive live vaccinations, please contact your transplant team for options. You can also check this Government of Canada website for recommended vaccines in general and by destination: Travel vaccinations – Travel.gc.ca
It is also important to purchase travel/medical insurance, and check the visa requirements for the destination(s) you are travelling to. Lastly, photocopy or take photos of your important documents, and keep the originals secure.
Ensure you have enough supply of all of your medications for the full length of your trip. Along with this, make sure you have a few days of extra medications in case there is a delay while travelling.
Transport your medications safely. If travelling by air, bring all of your medications and equipment in carry-on baggage. Never put medications or equipment in checked luggage. This will prevent them from getting lost, and you may also need your medications and/or equipment during the flight.
Contact your airline to notify them about medical devices, syringes, and liquid medications you may be bringing. You may need a doctor’s note in order to bring them on the plane.
Some medications are temperature-sensitive and require refrigeration. Bring these medications in an insulated bag or cooler. Ensure you have access to a fridge at your destination, either in your room or a common refrigerator you can use.
If you are travelling outside of Canada, make sure your medications are clearly labelled in original packaging. Every country has regulations about importing medication and some may require a doctor’s note. Be sure to check this in advance!
Certain medications and devices may be better-suited to travel. For example, dry-powder inhalers are easier to transport and store than solutions and nebulizers. Check with your CF team if more portable options are suitable for you.
Here are a few specific medication/medical device-specific requirements from Canadian airlines:
Do not check your equipment — always carry it on to make sure it will not be lost or damaged. Your medical equipment does not count against your carry-on allowance of one small carry-on bag and one personal item.
For medical devices such as COMPRESSORS, BiPAP, or CPAP, voltages outside of North American may be different. Find out about the electricity voltage, frequency, and type of plugs at your destination.
- In North America, the standard voltage is 110-120 V with a frequency of 60 Hz. In Europe, Australia and most of Asia and Africa, the standard voltage is 230 V and the frequency is 50 Hz. Generally, you cannot use North American compressors in Europe or Asia, regardless of adaptors or convertors. Speak to your Respiratory Therapist (RT) in clinic to discuss the best option for you.
Instead of bringing your own compressor, where possible you can buy or rent one once you have arrived at your destination. Prepare ahead of time by researching online or calling the local CF centre (if there is one) for advice
- Travel compressors exist that run on batteries (e.g. PARI Trek) but some people report it automatically stops running after 30 min to allow for cool down of the device. This may not be sufficient for someone who has multiple inhaled therapies. It then takes another 30 min for the device to start back up again.
- Depending on what medications you take, the PARI eFlow nebulizer with the correct handset, may be a solution as it runs on 4 AA batteries. E-rapid handset for Pulmozyme or Hypertonic saline; Altera handset for Cayston; Zirela handset for Quinsair.
- Remember to clean and disinfect your equipment after each treatment while travelling. Bacteria can be present, even in safe tap water, so make sure the water you are using is sterile. Water can be sterilized by boiling it for 10 minutes. Alternatively, you can use a microwave or electric steam sterilizer if you have access to these.
Here are some of the travel compressors your CF team may recommend:
Pari trek:
Pari Eflow Nebulizer System:
Oxygen levels in airplanes are lower than oxygen levels on land. This may pose a problem if you have low lung function. Speak with your doctor to determine whether it is safe for you to fly without extra oxygen. Your doctor may recommend a “high altitude assessment” which helps determine if you need oxygen to fly. In addition, your doctor may need to provide a “fitness to fly” letter which states that you have cystic fibrosis, if you require oxygen, and that you are well to travel.
If you need oxygen on your flight, or at your destination, make arrangements for oxygen rental before you book your vacation/travel. Some airlines allow you to bring your own oxygen with appropriate documentation, while others require that you use their oxygen (fees may apply).
- You can rent a portable oxygen concentrator (POC) from your home country. If oxygen is only needed for exertion and/or flying, a small pulse dose unit that goes up to 5 pulse dose may suffice. If oxygen is needed 24 hours per day, a larger POC may be required. Units that go up to 9 pulse dose and 3 litres per minute continuous flow are available. Battery time varies between units and with flowrate.
- It is recommended that the airline be notified that you are intending to travel with oxygen at the time you make your reservation and once again 48 hours before your flight time. Check with each airline about their requirements.
Usually you will be required to do the following:
1) Provide a prescription for oxygen,
2) Alert the airline that you are flying with a POC that is Federal Aviation Administration (FAA)- approved,
3) Organize your oxygen at least 1 month in advance, or
4) Organize your oxygen up to 6 months in advance if testing is required.
Here are a few specific oxygen requirements from Canadian airlines:
Portable nutritious snacks can help you meet your energy needs when travelling. Nuts, dried fruit, trail mix, beef jerky, and granola bars are easy options. Look for a granola bar with at least 8 grams of protein per serving for a more balanced snack. If you need to take a CFTR modulator while travelling, be sure to have a fat-containing snack to take with it. Some good options are: nuts and seeds, avocados, and string cheese.
When travelling to hot destinations, make sure you drink lots of fluid and eat salty foods to prevent dehydration. Carry a water bottle with you at all times and do not wait until you feel thirsty to drink.
Replace the salt that you are losing in your sweat through portable salty snacks such as chips, salted nuts and pretzels, beef jerky, and crackers. When eating out, salt your food liberally and consider adding cheese, pickles, or olives if it fits!
If you are eating out more often than usual, remember that many restaurant meals can be quite high in fat. Take additional enzymes to account for high fat meals. Speak to your dietitian if you have questions about enzyme dosing, or refer to the CF website: https://torontoadultcf.com/living-with-cf/nutrition/
If you urgently need medical care, ask the hotel staff to direct you and arrange transport to the nearest healthcare facility. If you are staying in a rental home, there is usually a binder or fridge magnet that has information about the nearest hospital’s location and dialing emergency services.
Bring your CF clinic’s emergency and general contact numbers, your passport, insurance documents, your “fitness to fly” letter and any other information about your medications (and your medications themselves!), and treatments to the medical centre.
If you pay for anything, always obtain a signed receipt. This can help with reimbursement of medical expenses. If you are unwell upon your return, please contact your CF clinic (or your family physician) as soon as possible.
Other tips:
- Follow infection prevention and control measures to reduce your risk of becoming unwell. This means bringing masks and washing hands with soap and water. If you cannot use soap and water, then clean your hands with hand sanitizer. Avoid street stall foods and unpasteurized products, they can pose risks for illness.
- Consider connecting with your dietitian to help estimate enzyme and insulin dosing with unfamiliar foods
- If you are travelling to an area with unsafe drinking water, then only drink water from sealed bottles. This means no ice cubes or juice mixes!
- Some antibiotics cause sun sensitivity. If you need to take them at a sunny destination make sure you avoid exposure and use sunscreen. You can ask your CF team to confirm if you are taking any.
- Scuba diving can be extremely dangerous for people with CF, even those with mild lung disease, because the changes in pressure that come with diving can cause a lung collapse or pneumothorax. If you are considering scuba diving, discuss with your CF doctor before your trip. Snorkeling does NOT have the same risks and is safe to do.
- For physiotherapy, ask the clinic physiotherapist for “hands free” options for Airway Clearance Therapy (ACT). This can be really handy if you’re travelling for a long time or have long layovers and do not have the luxury of a private space to perform ACT
- If you have diabetes, you may need to adjust your long-acting insulin times if you are travelling overseas across 5 or more time zones. Travelling east will shorten your day so you may need to decrease your insulin, while traveling west lengthens your day and may require more insulin. To get an idea of how to adjust your insulin, check out this diabetes travel calculator: https://diabetestravel.sansum.org. You can also meet with your CF care team to discuss how your insulin should be adjusted.
- If you have any questions about travelling, please contact your CF care team here
For more helpful tips, please visit CF Canada’s website: Travel Tips for Cystic Fibrosis | Cystic Fibrosis Canada Blog
You can also consult the Cystic Fibrosis Foundation’s “Before Travelling” series: Cystic Fibrosis Foundation | Before Travelling
Plan ahead, be prepared, and have a great trip!