When is it safe to fly after a pneumothorax (collapsed lung)?

When to Fly After Pneumothorax

Patients with a resolved pneumothorax should wait at least 7 days after radiological confirmation of complete resolution before flying on commercial aircraft. 1

Guidelines for Air Travel After Pneumothorax

For Patients with Resolved Pneumothorax

• Complete radiological resolution must be confirmed (at minimum by chest X-ray)
• Wait period after confirmed resolution:
  • 7 days after radiological confirmation of complete resolution 1
  • This waiting period is to exclude early recurrence

For Patients with Persistent Pneumothorax

• Patients with a persistent closed pneumothorax should not travel on commercial flights until complete radiological resolution 1
• The only exception is very rare cases of loculated or chronic localized air collections that have been carefully evaluated 1

Special Considerations

• After definitive surgical intervention (e.g., surgical pleurectomy):

  • May fly 6 weeks after surgery and resolution of pneumothorax 1
  • Surgical intervention significantly reduces recurrence risk

• Without definitive surgical intervention:

  • Higher risk of recurrence persists for up to 1 year 1
  • Patients may choose to avoid flying for a full year, especially those with:
    • Underlying lung disease
    • History of smoking
    • Secondary spontaneous pneumothorax 1

Risk Factors for Complications During Air Travel

Higher Risk Patients

• Patients with underlying lung disease 1
• Smokers 1
• Taller men 1
• Patients with history of secondary spontaneous pneumothorax 1

Physiological Concerns

• While there is no evidence that air travel precipitates recurrence of pneumothorax, recurrence during flight could have serious consequences 1
• At cabin altitude (8,000 ft/2,438 m), gas expansion occurs according to Boyle's law 2
• Modeling suggests sea-level pneumothorax up to 45% would be tolerable in otherwise healthy persons 2

Additional Activity Restrictions After Pneumothorax

• Avoid spirometry for 2 weeks after pneumothorax resolution 1
• Avoid lifting weights (>5 pounds) for 2 weeks after pneumothorax resolution 1
• Avoid scuba diving permanently unless a very secure definitive prevention strategy such as surgical pleurectomy has been performed 1

Follow-up Recommendations

• All patients should be followed by a respiratory physician to ensure resolution 1
• Follow-up chest X-ray should be performed 2-4 weeks after initial diagnosis to document resolution 3
• Patients should be given clear instructions to return to the emergency department immediately if they develop increased breathlessness 1, 3

Pitfalls and Caveats

• The traditional "6-week rule" for flying after pneumothorax appears to be arbitrary 1
• Recent evidence suggests air travel with a known pneumothorax may be safer than previously thought 4, but the most recent guidelines still recommend caution
• For trauma patients specifically, some evidence suggests flying may be safe as early as 72 hours after tube thoracostomy removal with documented resolution 5, but this should not override general pneumothorax guidelines
• Recurrence risk is highest in the first year after pneumothorax, with significant fall in risk only appearing after 1 year has elapsed 1

Remember that while these are general guidelines, the most important factor is radiological confirmation of complete resolution before flying, followed by the appropriate waiting period to ensure safety during air travel.