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WhatisAerotoxicSyndrome?
>Whydoesthecabinairgetcontaminated?
>Howoftendoesafumeeventoccur?
>HowcanItellifthecabinairiscontaminated?
>Howprevalentisnormalcontamination?
>Whatarethesymptoms?
>IsAerotoxicSyndrometreatable?
>Cananyonebeaffected?
>Areallaircraftpronetoengineoilleaks?
>Howlonghastheproblembeenknownaboutfor?
>Arethereanysolutions?
>Istheaviationindustryaddressingtheissue?
AerotoxicSyndromeisthetermgiventotheillnesscausedbyexposuretocontaminatedair
injetaircraft.
Thetermwasintroducedon20October1999byDrHarryHoffman,ProfessorChrisWinderand
JeanChristopheBalouet,Ph.D.intheirreport,AerotoxicSyndrome:Adversehealtheffectsfollowing
exposuretojetoilmistduringcommercialflights.

Whydoesthecabinairgetcontaminated?
Inordertohaveacomfortableenvironmentandsufficientairpressuretobreatheatthealtitudesat
whichjetairlinersfly,asupplyofwarmcompressedairisrequired.
Thisisnowadays(withthesoleexceptionofthenewBoeing787)supplieddirectfromthejet
enginesandisknownasbleedair.Itismixedinsidetheaircraftwithrecirculatedcabinairataratio
of50/50.Althoughsomeoftheairissubsequentlyrecirculated,alloftheairoriginatesfromthejet
engines.
Bleedaircomesfromthecompressorsectionofthejetengine,whichhastobelubricated.Jet
enginesmostlyhavewetsealstokeeptheoilandairapart,whichcannotbe100%effective.
Furthermoretheseseals,likeanymechanicalcomponent,slowlywearoutandtheireffectiveness
graduallydeclines.Thiswearcanoccurmorerapidlywhentheengineisworkinghard,suchas
climbingunderfullthrottle.Theymayalsofailsuddenlyandwillthenletasignificantamountofoil
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intotheveryhotcompressedbleedair,resultinginfumesand/orsmokeenteringthecabin.Thisis
knownasafumeevent.
Therearenofiltersinthebleedairsupplytostopthishappening.
Notethattheoilusedtolubricatejetenginesisnotbasedonpetroleumhydrocarbons,asare
lubricantsforinternalcombustionenginesusedinmotorcars,outboardmotors,tractorsetc.Jet
enginesoperateatmuchhighertemperaturesand,therefore,usespecialsyntheticchemicalsasoil.
Theyalsocontainorganophosphateadditivesasantiwearagentsandotheraromatichydrocarbons
asantioxidants.Someoftheoilgetspartiallydecomposed,i.e.chemicallyaltered(pyrolysed)due
tothehightemperaturesintheengine.
Insummary,thecontaminationiscomposedoftheoil,theadditives,andthedecomposition
products.Thetoxicityseemstobeduetothelasttwoofthesethree.
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Howoftendoesafumeeventoccur?
UKCommitteeonToxicityofChemicalsinFood,ConsumerProductsandtheEnvironment(COT)
acceptsthatfumeeventsoccuron1flightin100inits2007report(seepara69).
However,onsomeaircrafttypescrewsreportthattheyexperiencefumestosomedegreeonevery
flightandasthedefinitionoffumeeventisnotagreedupon,itmakesitimpossibletogiveatrue
figure.
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HowcanItellifcabinairiscontaminated?
Slightleakageofoilintothecabinmaybedetectedbysmell(descriptionssuchassweatysocks,
wetdog,vomit,sweetoilysmellhavebeenused).Backgroundlevelsofcontaminationmaynot
bedetectablebysmell.Ifafumeeventoccursbluishhazeorsmokeinthecabinmaybevisible.
Onlyvisiblesmokeisofficiallyreportedintheflightlog,leadingtounderreportingoftheactual
frequency.
Therearenochemicalsensorsinmodernjetaircraft.Thenosesoftheaircrewaretheonly
detectorsatthemoment.
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Translate

Howprevalentisnormalcontamination?
Bynormalwemeanslight(relativetoafumeevent)butsignificantcontamination.Thedegreeof
contaminationdependsonjetenginetypeandhowrecentlyitwasserviced,amongotherfactors.
Therearefewreliablemeasurementsbutbasedonwhathasbeendoneweestimatethatabouta
quarterofflightssufferslightbutsignificantcontamination.Itisimportanttorememberthatthis
contaminationmightbecontinuousthroughoutaflighthencethetotalexposuremightendupas
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muchasafterabrieffumeevent.
Swabtestingconfirmsthatfumeeventsalsodepositsubstantialresiduesonalltheinteriorsurfaces
ofthecabin,includingtheskinofthoseaboard.
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Whatarethesymptomsofaerotoxicsyndrome?
Symptomsmaybeacute,i.e.forashorttimeorchronic,i.e.longlasting.
Anycombinationofthefollowingmaybeexperienced:

Fatiguefeelingexhausted,evenaftersleep

Blurredortunnelvision

Shakingandtremors

Lossofbalanceandvertigo

Seizures

Lossofconsciousness

Memoryimpairment

Headache

Tinnitus

Lightheadedness,dizziness

Confusion/cognitiveproblems

Feelingintoxicated

Nausea

Diarrhoea

Vomiting

Coughs

Breathingdifficulties(shortnessofbreath)

Tightnessinchest

Respiratoryfailurerequiringoxygen

Increasedheartrateandpalpitations

Irritationofeyes,noseandupperairways.

whichiswhythetermsyndromeisused.Manygeneralmedicalpractitionersareunawareof
AerotoxicSyndromeandmaydiagnosesuffererswithillnessessuchaspsychologicalor
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psychosomaticdisorders(i.e.,theylltellyouitsallinyourmind),ChronicFatigueSyndrome
(CFS),mysteriousviralinfections,sleepdisorders,depression,stressoranxietyorsimplyjet
lag,whichiscausedbycrossingtimezones.
AlthoughsomeofthesedisordersmayformpartofAerotoxicSyndrome,suchpartdiagnoseson
theirownmisstherootcauseoftheproblem,whichisexposuretotoxicoilcomponentsina
confinedspace.Furthermore,anymisdiagnosisislikelytoleadtoinappropriatetreatments,which
maymaketheconditionevenworse.
AviationmedicinespecialistsareawareoftheproblembutAerotoxicSyndromedoesnotseemto
havegainedofficialacceptanceamongthemajorityofthem.Hence,despite(orbecauseof)their
expertknowledgetheyarelikelytoseekotherexplanationsandthereareplentyofneurological
symptomsassociatedwithaviationthathavenothingtodowithinhalingoil.
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IsAerotoxicSyndrometreatable?
Forshortexposures,theeffectsareusuallyreversibleandwillresolvethemselves.Butseriousor
repeatedlowdoseexposurescanleadtoseveresymptoms.Permanentneurologicaldamagemay
becaused,whichcannotberecoveredfrom.
Therearemanyprematurelymedicallyretiredaircrewwithmysteriousneurologicalsymptoms,
mosthavebeengrosslymisdiagnosed.
Thereisnomagiccure,buttherearespecialistswhomaybeabletohelpandstrategiestoaid
recovery.
Thefirststepistorecognisetheproblem,andavoidorlimitfurtherexposures.
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Cananyonebeaffected?
Yes.Thetoxinsattackthecentralnervoussystem(includingthebrain).Itsnoteasytopredicthow
differentexposuresmayaffectdifferentpeople,duetothegeneticvariabilityofindividuals.Hence,
onepersonsbodymayhavelesssuccessthananothersatdetoxifyingcontaminantsandsobe
affectedafterjustoneflight,whilstothersmaybeunaffectedafteryearsofexposure.Dependingon
detoxifyingefficiency,theadversehealtheffectsmaybecumulative.Therefore,anyonefrequently
flying(whichmeansonceormoreaweek)isrepeatedlyexposedandisthereforeespeciallyatrisk.
Evenafteraseriousfumeevent,itispossiblethatnosymptomsshowinitially,butafewdayslaterill
healthassociatedwithAerotoxicSyndromemaykickin.
Anyoneintheaircraftcanpotentiallybeaffected,whetherpilots,cabincrew/flightattendants,
passengers,firstclass,economy,minorsetc.
Airlinesprovidenoprotectiontopassengersagainstfumeevents.Dropdownmasksarenot
effectiveforremovingcontaminants.ThisisbecausetheoxygensuppliedbythesemasksisONLY
allowedtobeusedintheeventofcabindecompressionandsuppliesamaximumof20minutesof
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oxygen,whichismixedwithcontaminatedcabinair.
Activatedcarbonfacemaskscanoffersomeprotectionfromtoxicoilfumes,butcanneverprovide
100%protection.
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Areallaircraftpronetoengineoilleaks?
Alljetaircraftincludingturbopropsaresusceptibletofumeevents.
SomeaircrafthaveaworsehistorywiththeworstoffendersbeingtheBAe146,Boeing757.
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Howlonghastheproblembeenknownabout?
ThefirstwelldocumentedcasewasofaC130Herculesnavigatorbecomingincapacitatedafter
breathingcontaminatedcabinairin1977.Theneurotoxicpropertiesoforganophosphateshave
beenknownaboutsincebeforetheSecondWorldWar.Thetoxicityofheatedjetoilwasknown
from1954.
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Arethereanysolutions?
Intodaysexistingmodernbleedairaircraft,thequalityofcabinaircouldbeimproved,andtherisk
ofcontaminationbyengineoilreduced,withtheseknownsolutions:

ThenewBoeing787Dreamlineristheobviousanswerasiteliminatesthepossibilityofcabin
aircontamination.Insteadofbleedair,cabinairissuppliedbyelectricallydrivencompressors
takingtheirairdirectlyfromtheatmosphere.

Asbleedairisnotpresentlyfiltered,installationofbleedairfiltrationsystemswouldeliminate
theproblem,althoughatechnicallyefficientsystemdoesnotyetseemtohavebeen
developed.

Alesstoxicoilformulationcouldleadtosignificantimprovement.TheFrenchoilcompany
NYCOiscontinuouslydevelopingsuchoils.

Chemicalsensorstodetectcontaminatedairinthebleedairsuppliesinsteadofhuman
noseswouldalertpilotstoproblems,allowingpromptpreventiveaction.

Backtothetop

Istheaviationindustryaddressingtheissue?
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Numerousindependentscientificstudieshaveproducedclearevidenceofcontaminatedcabinair
beingthecauseofchronichealthproblems.Ontheotherhand,variousgovernmentsand
regulatoryauthoritieshavecommissionedresearch,which,whileadmittinganassociationbetween
contaminatedcabinairandchronichealthproblems,havestoppedshortofadmittingcausation.
Theaviationindustryhastendedtousethelattersetofresearch(despiteitsoftendubiousscientific
quality)todenytheexistenceoftheproblem,whileignoringtheevidenceoftheindependentstudies
orvictimstestimonies.
Onefeatureofthecomplexinternationalsituationofaviationisthattheregulatingauthorities,while
nominallygovernmentagencies,areactuallyfinancedandcontrolledbytheaviationindustryand
thereforefollowtheindustrysdesires.
Doubtlessmindfuloftheexpenseofaddressingtheissue,industrymaintainthereisnoevidence
whilsttacitlyacknowledgingthereisaproblemasshownbytheintroductionofthenewBoeing787.
Untilnowthishasbeenasustainablestrategybecausefewdoctors,aircreworpassengersare
awareofaerotoxicityandAerotoxicSyndrome.

Asof21stSeptember2012thereare31pilotscurrentlyontheUKCivilAviationAuthority(CAA)
MedicalDepartmentsdatabasewhohavesuggestedanassociationbetweenillnessesandthe
cabinenvironment.
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