Travel pathologies: Economy Class Syndrome

By Cristiano Antonino Last updated Nov 11, 2022

What is Economy Class Syndrome? Anyone who has experience of flying, either as a traveller or as a crew member, also has experience of signs and symptoms of venous insufficiency of the lower extremities that can strike during and after a long air journey

Airlines have long been confronted with Economy Class Syndrome:

This definition refers to a newly identified symptom parade characterised by declivous oedemas in the lower limbs that particularly affects travellers and airline operators.

It ranges from a simple, harmless swelling of the legs to complicated pictures of phlebitis, thrombosis and thromboembolic disease, so much so that pulmonary embolism is the leading cause of ‘airport death’ worldwide.

It particularly affects those who are already predisposed to and suffer from venous insufficiency (varicose veins in particular), but also affects apparently healthy individuals with no personal or family history of venous disease.

The causes of Economy Class Syndrome

Economy Class Syndrome is mainly due to water retention that occurs on long air journeys and recognises immobilisation in confined spaces associated with pressurised travel rooms and poor hydration as important contributory causes.

This leads to venous overload with blood stasis that predisposes to coagulation (thrombosis).

Tips

Advice to reduce its incidence (use of elastic stockings, hydration, frequent mobilisation) is sometimes insufficient, especially if predisposing and pre-existing causes are unknown.

Airlines have already set up fairly effective information campaigns, which can still be improved, for passengers.

But those who work on planes can develop clinical pictures over time, ranging from simple dilated capillaries to real varicose veins with the related disorders and complications: persistent oedema, paresthesias, itching, pain, restlessness, cramps, phlebitis, thrombosis, pulmonary embolism, stasis eczema, ulcerations.

Such symptoms, when they converge into overt pathologies, could even be claimed as occupational diseases.