In summary, the environmental stresses of commercial air travel and the possibility of altitude-induced adverse events during flight suggest the importance of evaluating prospective air travelers with chronic pulmonary disease for in-flight supplemental oxygen needs. Although gaps exist in current understanding of the risks of air travel and optimal ways of predicting the need for in-flight oxygen, respiratory clinicians can use available techniques to assess travelers' in-flight oxygen needs in many instances. Significant current variation among commercial air carriers in policies regarding providing oxygen, related equipment, and the cost of in-flight oxygen poses challenges to the prospective air traveler and warrants attention.
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