Management of Primary Spontaneous Pneumothorax in Flight Crew

Primary spontaneous pneumothorax is a thoracic disorder, characterised by an abnormal collection of air in the pleural space, occurring in the absence of underlying lung disease. In aviation medicine, it is a particular pathology that influences flight crew member's fitness to fly. Occurring in apparently healthy individuals, the severity of symptoms varies depending on the size of the pneumothorax, ranging from moderate chest pain and/or dyspnoea to haemodynamic disorders in tension pneumothorax. A chest X-ray is sufficient for the diagnosis. Treatment options include observation, simple aspiration, chest tube insertion, pleurodesis, thoracoscopy, video-assisted thoracoscopic surgery, and thoracotomy.

After a first episode of pneumothorax, the risk of recurrence varies from 20% to 60%, it increases to 62% after a second episode and to 83% after a third episode. Aeronautical physicians are concerned about in-flight recurrence, as related symptoms are likely to affect the performance of the pilots and may result in an aviation accident. The aeronautical environment subjects the body to stresses, which vary according to the type of aeronautical activity carried out, and which are likely to encourage the recurrence of pneumothorax, the two main stresses are altitude hypobaria and longitudinal accelerations (+Gz). To prevent the recurrence of in-flight pneumothorax, pleurodesis is required for fighter, aerobatic pilots and monopilote, while apical pleurectomy associated with abrasion of the remaining pleura and resection of bullae/blebs is necessary for fighter pilots to recover unrestricted aeronautical fitness. For the other categories of flight personnel, the treatment is similar to that of the general patient.