Without definitive intervention, individuals with an untreated pneumothorax should not participate in commercial flying. Whether this advice applies to patients with a long-standing pneumothorax is uncertain. We report two adults with persistent pneumothoraces who underwent further investigation to determine the safety of doing so.
Following clinical assessment, both subjects had chest computerised tomographic (CT) imaging and underwent a hypoxic challenge test (breathing 15% oxygen). The individuals then proceeded to cabin altitude simulation in a hypobaric chamber.
Case 1 - Chest CT showed a small left pneumothorax (estimated volume 110 millilitres). During a hypoxic challenge test, the oxygen saturation fell to 90%. During cabin altitude simulation, the patient remained asymptomatic and oxygen saturation fell to 90%. He was considered fit to fly and has completed over a dozen transatlantic flights without difficulty.Case 2 - Chest CT showed a loculated right sided pneumothorax (estimated volume 250 millilitres) and during a hypoxic challenge test, the oxygen saturation fell to 93%. An altitude chamber test was tolerated without symptoms and the oxygen saturation fell to a minimum of 92%. She was therefore considered fit to fly in commercial aircraft.
Some patients with a closed chronic pneumothorax can fly without adverse consequences.
This risk should be determined after thorough assessment incorporating chest CT, a hypoxic challenge test and simulation of flying at altitude in a decompression chamber with close monitoring of symptoms and oxygen saturation.
Graeme Currie, None.