Abstract

This paper is outlines current knowledge and personal experience gained in
managing a significant number of aircraft cabin and flight deck crew and some
passengers and aircraft engineers, both nationally and internationally, who have
presented with respiratory and other complaints, which have occurred after
exposure to toxic fumes on board an aircraft cabin over a twelve year period.

SPECIAL INVESTIGATIONS
In general, experience shows that respiratory and other investigations are rarely undertaken at initial presentation. Unfortunately it is commonplace that appropriate tests are not considered until a later date, when symptoms continue. Delay may result in missing the opportunity to physically or chemically detect abnormality. For example,
if volatile hydrocarbons are to be detected in the blood stream, serum samples need to be taken promptly before the substance is completely eliminated from the circulation. As in many cases the symptoms remit with time, special tests undertaken remotely may no longer show abnormality and, hence, the real incidence of abnormalities remains unknown. From the respiratory view point, standard tests of spirometry and diffusing
capacity are commonly found to be within the normal range. Chest X-rays and high resolution CT chest scans almost never get taken at the time of injury or within a
short period, so it is difficult to know whether there are any acute radiological changes. Some of those who complain of breathlessness upon exertion and who have
normal standard lung function tests (spirometry, diffusing capacity) have been shown to have an elevated alveolar-arterial oxygen gradient, implying that there has been an
injury to the lung at the alveolar-capillary membrane level. Thus tests of greater sensitivity, in this case arterial blood gas analysis, may reveal more subtle lung injury. Finally, there are no specific diagnostic tests for the aerotoxic syndrome, which contributes to its lack of general acceptance as a real entity

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