Travelers with Chronic Illnesses
General Travel Preparation: Practical Considerations
Although traveling abroad can be relaxing and rewarding, the physical demands of travel can be stressful, particularly for travelers with underlying chronic illnesses. With adequate preparation, however, such travelers can have safe and enjoyable trips. General recommendations for advising patients with chronic illnesses include:
- Ensure that any chronic illnesses are well controlled. Patients with an underlying illness should see their health care providers to ensure that the management of their illness is optimized.
- Encourage patients to seek pretravel consultation ≥4–6 weeks before departure to ensure adequate time to respond to immunizations and, in some circumstances, to try medications before travel (see the Immunocompromised Travelers section earlier in this chapter).
- Advise patients to consider a destination where they have access to care for their condition.
- Ask about previous health-related issues encountered during travel, such as complications during air travel.
- Advise the traveler about packing a health kit (see Chapter 2, Travel Health Kits).
- Advise travelers to pack medications and medical supplies (such as pouching for ostomies) in their original containers in carry-on luggage and to carry a copy of their prescriptions. Ensure the traveler has sufficient quantities of medications for the entire trip, plus extra in case of unexpected delays. Since medications should be taken based on elapsed time and not time of day, travelers may need guidance on scheduling when to take medications during and after crossing time zones.
- Advise travelers to check with the US embassy or consulate to clarify medication restrictions in the destination country. Some countries do not allow visitors to bring certain medications into the country, especially narcotics and psychotropic medications.
- Educate travelers regarding drug interactions (see Chapter 2, Interactions among Travel Vaccines & Drugs). Medications (such as warfarin) used to treat chronic medical illnesses may interact with medications prescribed for self-treatment of travelers’ diarrhea or malaria chemoprophylaxis. Discuss all medications used, either daily or on an as-needed basis.
- Provide a clinician’s letter. The letter should be on office letterhead stationery and should outline existing medical conditions, medications prescribed (including generic names), and any equipment required to manage the condition.
- Suggest supplemental insurance. Three types of insurance policies can be considered: 1) trip cancellation in the event of illness; 2) supplemental insurance so that money paid for health care abroad may be reimbursed, since most medical insurance policies do not cover health care in other countries; and 3) medical evacuation insurance (see Chapter 2, Travel Insurance, Travel Health Insurance, & Medical Evacuation Insurance). Travelers may need extra help in finding supplemental insurance, as some plans will not cover costs for preexisting conditions.
- Encourage travelers with underlying medical conditions to consider choosing a medical assistance company that allows them to store their medical history so it can be accessed worldwide (see Chapter 2, Obtaining Health Care Abroad).
- Help travelers devise a health plan. This plan should give instructions for managing minor problems or exacerbations of underlying illnesses and should include information about medical facilities available in the destination country (see Chapter 2, Obtaining Health Care Abroad).
- Advise travelers to wear a medical alert bracelet or carry medical information on his or her person (various brands of jewelry or tags, even electronic, are available).
- Advise travelers to stay hydrated, wear loose-fitting clothing, and walk and stretch at regular intervals during long-distance travel (see Chapter 2, Deep Vein Thrombosis & Pulmonary Embolism).
- Consider advising the traveler to use a mobile application to track certain chronic illnesses, such as diabetes, while traveling.
Specific Chronic Illnesses
Issues related to specific chronic medical illnesses are addressed in Table 8-3. These recommendations should be used in conjunction with the other recommendations given throughout this book. Below is a noninclusive list of additional resources for information:
- American Association of Kidney Patients (www.aakp.org)
- American Diabetes Association (www.diabetes.org)
- American Heart Association (www.heart.org)
- American Lung Association (www.lung.org)
- American Society of Clinical Oncology, Cancer.Net (www.cancer.net)
- American Thoracic Society (www.thoracic.org)
- Anticoagulation Forum (www.acforum.org)
- British Thoracic Society (www.brit-thoracic.org.uk)
- Crohn’s and Colitis Foundation of America (www.ccfa.org)
- Global Dialysis (www.globaldialysis.com)
- International Narcotics Control Board (www.incb.org)
- International Self-Monitoring Association of Oral Anticoagulated Patients (www.ismaap.org)
- National Multiple Sclerosis Society (www.nationalmssociety.org)
- Transportation Security Administration (www.tsa.gov)
- Department of State (www.state.gov)
|Condition||Absolute and Relative Contraindications to Airline Travel||PreTravel Considerations||Immunization Considerations||Miscellaneous|
|Renal failure and chronic renal insufficiency||None|
|Severe allergic reactions||None|
|Autoimmune and rheumatologic diseases||None||Should have a baseline TST or IGRA before starting TNF blockers||Particular emphasis should be placed on food and water precautions and hand hygiene|
|Abbreviations: DVT, deep vein thrombosis; CHF, congestive heart failure; CABG, coronary artery bypass graft; CVA, cerebrovascular accident; EKG, electrocardiogram; AICD, automatic implantable cardioverter defibrillators; INR, international normalized ratio; COPD, chronic obstructive pulmonary disease; TD, travelers’ diarrhea; PPIs, proton-pump inhibitors; YF, yellow fever; CrCl, creatinine clearance; AAKP, American Association of Kidney Patients; FSBG, fingerstick blood glucose; TST, tuberculin skin test; IGRA, interferon-γ release assay; TNF, tumor necrosis factor.|
Travelers may also want to investigate international health care accreditation agencies for centers that have been awarded recognition for high standards and good patient safety records. If travelers or their health care providers have concerns about fitness for air travel or the need to obtain a medical certificate before travel, the medical unit affiliated with the specific airline is a valuable source for information. Remember to notify the airline in advance if oxygen or other equipment is needed on the plane. The TSA Cares Helpline (toll-free at 855-787-2227) can also provide information on how to prepare for the airport security screening process with respect to a particular disability or medical condition.
- Aerospace Medical Association. Medical Guidelines for Airline Travel. 2nd ed. Alexandria, VA: Aerospace Medical Association; 2003 [cited 2016 Sep. 27]. Available from: http://www.asma.org/asma/media/asma/Travel-Publications/medguid.pdf.
- Exemption from import/export requirements for personal medical use. 21 CFR Part 1301; 2004 [cited 2016 Sep. 27]; Available from: http://www.deadiversion.usdoj.gov/fed_regs/rules/2004/fr0914.htm.
- IATA. Medical Manual. 2015 [cited 2016 Sept 27]; 7th:[Available from: www.iata.org/publications/Pages/medical-manual.aspx.
- Josephs LK, Coker RK, Thomas M, British Thoracic Society Air Travel Working Group. Managing patients with stable respiratory disease planning air travel: a primary care summary of the British Thoracic Society recommendations. Prim Care Respir J. 2013 Jun;22(2):234–8. [PMID:23732637]
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- Pinsker JE, Becker E, Mahnke CB, Ching M, Larson NS, Roy D. Extensive clinical experience: a simple guide to basal insulin adjustments for long-distance travel. J Diabetes Metab Disord. 2013;12(1):59. [PMID:24360506]
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Deborah Nicolls Barbeau