What activities should be avoided after experiencing a pneumothorax?

Activities to Avoid After Pneumothorax

Avoid all strenuous activities including lifting more than 5 pounds, air travel, and spirometry for a minimum of 2 weeks after radiographic resolution of your pneumothorax, and permanently avoid scuba diving unless you undergo definitive surgical prevention. 1

Immediate Restrictions (First 2 Weeks After Resolution)

Weight Lifting and Strenuous Exercise

• Do not lift anything heavier than 5 pounds for at least 2 weeks after radiographic resolution 1
• This restriction exists because lifting generates high intrathoracic pressures that can precipitate recurrence 1
• While evidence on general exercise restrictions lacks clear consensus, a conservative 2-week minimum abstinence from all strenuous exercise is the prudent clinical approach 1

Air Travel

• Do not fly for a minimum of 2 weeks after radiographic resolution 1, 2
• The British Thoracic Society recommends waiting at least 7 days after confirmed resolution, but the American Thoracic Society extends this to 2-6 weeks, particularly for secondary pneumothorax 2
• Some experts recommend extending the restriction to 4-6 weeks for higher-risk patients 1
• Gas expansion at altitude (Boyle's law) can cause pneumothorax recurrence or expansion during flight 3

Medical Testing

• Avoid spirometry and pulmonary function testing for 2 weeks after resolution 1, 2
• Forced expiratory maneuvers during spirometry generate dangerously high intrathoracic pressures that risk recurrence 1

Respiratory Support

• BiPAP must be withheld while any pneumothorax is present, as positive pressure ventilation can worsen the condition 1, 2

Follow-Up Requirements Before Activity Clearance

Radiographic Confirmation

• Obtain a follow-up chest radiograph at 2-4 weeks after initial treatment to confirm complete resolution 1, 2
• After radiographic resolution is confirmed, wait an additional minimum of 7 days to exclude early recurrence before clearing any activities 1, 2

Permanent Restrictions

Scuba Diving

• Scuba diving should be permanently avoided after pneumothorax unless you undergo definitive surgical prevention such as pleurectomy 1, 2
• Pressure changes during diving cause more severe consequences than air travel 2
• This is a non-negotiable restriction due to the life-threatening risk of underwater pneumothorax expansion

Practical Timeline for Activity Resumption

Weeks 0-2 from resolution:

• Complete activity restriction except light daily activities 1
• No weightlifting, no air travel, no spirometry 1

Weeks 2-4:

• Obtain follow-up chest radiograph to confirm complete resolution 1

After radiographic resolution + 7 days minimum:

• May consider gradual return to activities 1
• Conservative approach suggests waiting full 2 weeks from confirmed resolution 1

For air travel specifically:

• Minimum 2 weeks from resolution for uncomplicated primary pneumothorax 1
• Consider extending to 4-6 weeks for secondary pneumothorax or high-risk patients 1
• Patients with cystic fibrosis should wait at least 2 weeks 2

Special Populations

High-Risk Occupations

• For airline pilots, military personnel, and other at-risk professionals, consider elective surgical pleurodesis after the first pneumothorax episode to prevent recurrence 1, 2
• This allows earlier return to critical occupational activities with reduced recurrence risk

Cystic Fibrosis Patients

• Require more aggressive management with surgical intervention often considered after first episode 2
• Must wait at least 2 weeks before air travel 2

Critical Pitfalls to Avoid

• Never clear a patient for activities without radiographic confirmation of complete resolution 1, 2
• Do not rely on symptom resolution alone—asymptomatic pneumothorax can persist 1
• Do not underestimate the recurrence risk with premature activity resumption 1
• Ensure all patients understand the permanent scuba diving restriction 1, 2