From the Guidelines
It is recommended to wait at least 7 days after complete resolution of a pneumothorax, confirmed by a chest X-ray, before flying. This recommendation is based on the most recent and highest quality study, the British Thoracic Society guideline for pleural disease, published in 2023 1. The guideline states that patients with a resolved pneumothorax confirmed radiologically can fly 7 days after the X-ray demonstrates full resolution. This waiting period is intended to exclude early recurrence and ensure that the pneumothorax has fully resolved.
The decreased cabin pressure during flight can cause any remaining air in the pleural space to expand, potentially leading to recurrence or worsening of the pneumothorax. Therefore, it is essential to wait until the pneumothorax has fully resolved before flying. A follow-up chest X-ray confirming complete resolution is typically required before travel clearance is given.
Individual factors, such as the size of the original pneumothorax, treatment method, presence of underlying lung disease, and recovery progress, will influence the safe waiting period. Patients should always obtain clearance from their treating physician before flying. The British Thoracic Society guideline provides the most up-to-date and evidence-based recommendations for the management of pneumothorax, including air travel advice.
Some key points to consider when advising patients on air travel after a pneumothorax include:
- The risk of recurrence or worsening of the pneumothorax during flight
- The importance of obtaining clearance from a treating physician before flying
- The need for a follow-up chest X-ray to confirm complete resolution of the pneumothorax
- The individual factors that influence the safe waiting period, such as the size of the original pneumothorax and the presence of underlying lung disease.
Overall, the recommendation to wait at least 7 days after complete resolution of a pneumothorax before flying is based on the most recent and highest quality evidence, and is intended to minimize the risk of recurrence or worsening of the pneumothorax during air travel.
From the Research
Pneumothorax and Air Travel
The question of how long someone with a pneumothorax should wait to fly is complex and has been addressed by several studies.
- The traditional guidelines have suggested waiting until the complete resolution of a pneumothorax before flying, with some recommendations advising a wait of 1 to 3 weeks after thoracic surgery or resolution of the pneumothorax 2.
- However, more recent evidence suggests that air travel with a known pneumothorax may be safe sooner than current guidelines advise 3.
- A study published in 1999 found that commercial air travel appears to be safe 14 days following radiographic resolution of a traumatic pneumothorax 4.
- Another study used a mathematical model to investigate the effects of pneumothorax expansion at altitude and found that sea-level pneumothorax up to 45% would be tolerable in otherwise healthy persons 5.
Timing of Safe Air Travel
The timing of safe air travel after a pneumothorax is not well established, and more research is needed to inform decisions regarding air travel for patients at risk for pneumothorax.
- A review of the literature found a paucity of data on the issue and noted that true evidence-based recommendations are difficult to develop at this time 6.
- However, some studies suggest that air travel may be safe sooner than traditionally thought, and that the risk of complications may be lower than previously believed 3, 5.
- Ultimately, the decision to fly after a pneumothorax should be made on a case-by-case basis, taking into account the individual's overall health and the severity of the pneumothorax.