Safety of Air Travel Post Pneumothorax and Post Lung Resection

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BACKGROUND

As thoracic surgeons, our patients look to us to guide their safe recovery and return to normal activities. In this guideline we address the safety of commercial air travel in two settings:

  1. Post spontaneous pneumothorax
  2. Post lung resection

RECOMMENDATION

There is a paucity of evidence to guide thoracic surgeons and thus their patients on the safety of commercial air travel in either setting.  There are no prospective studies in either case. All recommendations are based on expert opinion and retrospective data.

  1. The presence of a pneumothorax is considered an absolute contraindication to air travel due to the potential to expand in flight. For patients post spontaneous pneumothorax, current guidelines suggest between one and three weeks between complete radiographic resolution and commercial air travel. The optimal timing is unknown. Factors that may prompt the thoracic surgeon to advise a more conservative time frame include:
    • Underlying lung disease, especially:
      • Severe bullous emphysema
      • Lymphangioleiomyomatosis
      • Birt-Hogg-Dube Syndrome
    • Limited cardiopulmonary reserve
    • Whether the patient received an intervention and how definitive that was deemed to be
  1. For patients post lung resection, data is again lacking to inform return to air travel. Accordingly, guidelines give discretion to the surgeons and practice patterns vary widely.  In the only sizeable study, which was a retrospective survey design, there was no significant difference in adverse events according to air travel vs ground travel upon discharge post lung resection.

REFERENCES

Aerospace Medical Association Guidelines Task Force. Medical Guidelines for Airline Travel. 2nd Ed. Aerospace Medical Association. Alexandria, VA. 2003.

Cassivi SD et al. Safety of air travel in the immediate postoperative period after anatomic pulmonary resection. JTCVS 2017;153:1191-6.

Coker RK et al. BTS Clinical Statement on air travel for passengers with respiratory disease. Thorax 2022;77:329-350.

Hu X et al. Air travel and pneumothorax. CHEST 2014;145(4):688-694.

Sacco F and Calero KR. Safety of air travel after treatment of traumatic pneumothorax. Int J Circumpolar Health. 2014;73:1.

Simpson A et al. Can patients travel by air less than 1 week after lung nodulectomy. Innov. 2021;16(6):553-558.

Szymanski TJ et al. Expansion of postoperative pneumothorax and pneumomediastinum: determining when it is safe to fly. Aviat Space Environ Med. 2010;81(4):423.