Further research is required to address the exact rate of pneumothorax during and directly after air travel. Preferably, a healthy control group is used to address the pneumothorax rate in the general population. Since pneumothorax during diving is reported to be associated with serious complications, and screening for cysts has been suggested in professional divers, we recommend that BHD patients are evaluated and counselled on the potentially associated risk by a physician with experience in diving medicine.
MJ provided statistical analysis, provided a substantial contribution to review and revise the manuscript critically, gave final approval of the version to be published and agreed to be accountable for all aspects of the work.
JHTMvW, RR, ThMS, RJAvM: provided a substantial contribution to review and revise the manuscript critically, supervised the analysis and interpretation of the clinical patients data, gave final approval of the version to be published and agreed to be accountable for all aspects of the work.
FHM provided a substantial contribution to review and revise the manuscript critically, supervised the analysis and interpretation of the clinical patients data, supervised as attending clinical geneticist, gave final approval of the version to be published and agreed to be accountable for all aspects of the work. PEP provided a substantial contribution to review and revise the manuscript critically, supervised the analysis and interpretation of the clinical patients data, supervised as attending pulmonologist, gave final approval of the version to be published and agreed to be accountable for all aspects of the work.
All authors read and approved the final manuscript. We thank all the participants in this study for their extensive contribution. Paul, Email: ln. Houweling, Email: ln. Jonker, Email: ln. Reinhard, Email: ln. Starink, Email: moc. Menko, Email: ln. Postmus, Email: moc. National Center for Biotechnology Information , U.
Published online Sep 7. Johannesma , 1 I. Paul , 3 A. Houweling , 2 M. Jonker , 4 J. Reinhard , 5 Th. Starink , 6 R. Menko , 8 and P. Postmus 9, Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Feb 8; Accepted Aug 5. This article has been cited by other articles in PMC. Methods A questionnaire was sent to a cohort of BHD patients and the medical files of these patients were evaluated.
Results In total Conclusion Based on the results presented in this retrospective study, exposure of BHD patients to considerable changes in atmospheric pressure associated with flying and diving may be related to an increased risk for developing a symptomatic pneumothorax.
Background Changes in atmospheric pressure are related to a higher incidence of spontaneous primary pneumothorax. Results Demographics In total Glyfs 5 Yes Yes Yes Pleurodesis c. Glyfs 6 Yes 4 Yes No Pleurodesis c.
Open in a separate window. Spontaneous pneumothorax after air travel Sixty-one of BHD patients Spontaneous pneumothorax after diving Two patients out of 54 that had ever dived 3. Discussion To date, our study is the largest air travel and diving survey of patients diagnosed with BHD. Acknowledgements We thank all the participants in this study for their extensive contribution. Competing interests The authors declare that they have no competing interests.
Contributor Information P. References Baumann MH. Pneumothorax and air travel: lessons learned from a bag of chips. Spontaneous pneumothorax related to falls in atmospheric pressure. Eur J Respir Dis. Influence of atmospheric pressure, outdoor temperature, and weather phases on the onset of spontaneous pneumothorax.
Ann Epidemiol. Comprehensive evaluation of 35 patients with lymphangioleiomyomatosis. Is air travel safe in thorse with lung disease? Eur Respir J. Respiratory bronchiolitis in smokers with spontaneous pneumothorax.
Pulmonary barotrauma. Diving and subaquatic medicine. Sydney: Butterworth-Heinemann Medical; Influence of weather conditions on the onset of primary spontaneous pneumothorax: positive association with decreased atmospheric pressure.
Ann Thorac Cardiovasc Surg. Air travel and pneumothorax. Folliculin, the product of the Birt—Hogg—Dube tumor suppressor gene, interacts with the adherens junction protein p to regulate cell-cell adhesion.
Lancet Oncol. Outcomes of medical emergencies on commercial airline flights. N Engl J Med. Most patients already on domicillary oxygen therapy use flow rates of 1 to 2 litres per minute, and so in flight will require 2 to 4 litres per minute, as supplied by major airlines through a face mask.
Few airliness routinely supply higher flow rates - this makes air travel difficult for more severe respiratory patients without a medical escort. Specialist opinion may be required NICE suggest that 2 : all patients on long term oxygen therapy planning air travel should be assessed in line with the BTS recommendations all patients with an FEV1 all patients known to have bullous disease should be warned that they are at a theoretically increased risk of developing a pneumothorax during air travel COPD and scuba diving scuba diving is not generally recommended for patients with COPD.
Advise people with queries to seek specialist advice 2 cystic fibrosis - significant desaturation can take place during a flight. Specialist opinion should be sought The following table is provided as a guide only to the timeframe that should elapse between a medical event and the intended flight. The timeframes may be changed following considered medical assessment of a specific case 4,5 : Diagnosis Assessment required by a doctor with aviation medicine experience Accept as fit to fly if: Comments Pneumothorax air in the cavity around the lung due to a puncture wound or spontaneous 6 days or less after full inflation.
Supplementary oxygen needed at ground level. Full recovery if recent exacerbation. No current infection Asthma Currently asymptomatic and no infection Remind to carry usual prn medication in carryon luggage.
Bronchiectasis Hypoxaemic at ground level No current infection Detailed consideration of specific conditions 4,5 Asthma normal aircraft cabin environment does not represent a specific challenge to those suffering from asthma that is stable key issue is to ensure that all medication is carried in hand baggage. It may be prudent that patients with asthma, other than the mildest cases, should take a course of oral steroids with them, in order that they could intervene early if there is any deterioration in their condition.
Oxygen can be provided by most airlines with prior notification flow rates of 2 or 4 litres per minute are usually available and some airlines may be able to offer a wider range of flow rates using cylinders with pulse dose delivery systems some airlines may permit passengers to carry and use their own oxygen cylinders and passengers who wish to do this should contact the airline for information on their policy passengers may also be able to use approved portable oxygen concentrators and again those wishing to do so should discuss this with the airline Bronchiectasis and cystic fibrosis control of lung infection measures designed to loosen and clear secretions are important aspects of medical care, both on the ground and during travel.
Appropriate antibiotic therapy, adequate hydration and medical oxygen may be required for both conditions. Medication to decrease sputum viscosity is helpful e. Due to the pressure changes during air travel, cystic air spaces expand and compress in the thorax possibly leading to cyst rupture and pneumothorax. In their new study, Gupta et al. This study classified any pneumothorax occurring either during a flight or within 24 hours after as a flight related pneumothorax.
Differently, considering symptom delay, a recent study discussed on a previous blog classified any pneumothorax that happened within one month of air travel as flight related pneumothorax Johannesma et al. Here, the limit to 24 hours meant to distinguish between a flight related SP and an unrelated SP that happened to occur after a flight. The survey results showed that the average age at diagnosis of BHD was 47 years, with an average delay from first symptoms of 13 years.
The mean age at first and second pneumothorax was
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