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Pneumothorax and air travel

Lawrence C Mohr, MD, FACP, FCCP
Section Editors
James K Stoller, MD, MS
V Courtney Broaddus, MD
Deputy Editor
Geraldine Finlay, MD


It is estimated that over one billion passengers travel by air each year [1-3]. Although up to 5 percent of passengers have some form of disability or chronic medical illness, in-flight emergencies are infrequent [4]. Only one of every 39,000 passengers (0.003 percent) experiences an in-flight medical problem serious enough to come to the attention of emergency personnel [5,6]. Death during commercial flight is even rarer. During the year July 1998 to July 1999, the Federal Aviation Administration (FAA) collected medical events data, and 43 deaths occurred in-flight out of 600 million passengers [7].

The incidence, pathogenesis, and management of in-flight and previous pneumothorax/pneumomediastinum (PTX/PMD) will be reviewed here. Pre-flight medical assessment, the prevention of in-flight hypoxemia in patients with underlying lung disease, and the management of spontaneous PTX are discussed separately. (See "Assessment of adult patients for air travel" and "Traveling with oxygen aboard commercial air carriers" and "Primary spontaneous pneumothorax in adults" and "Secondary spontaneous pneumothorax in adults" and "Imaging of pneumothorax" and "Placement and management of thoracostomy tubes".)


The exact incidence of pneumothorax/pneumomediastinum (PTX/PMD) during commercial air travel is unknown due to non-standardized reporting requirements for in-flight medical emergencies, difficulty in making an in-flight diagnosis, and possible delay in symptoms [8]. Anecdotal reports of in-flight pneumothoraces have been published [9-11]. However, in-flight PTX must be rare, because it is not mentioned in most reports addressing in-flight emergencies [5,6,12-14].

A few reports have described the experience of individuals at high risk for pulmonary complications during air travel [15-17]:

In a series of 1115 passengers referred to an airline medical advisory service for pre-flight evaluation, 704 had chronic obstructive pulmonary disease (COPD) or another pulmonary disorder [15]. Over 90 percent were "cleared" for transport. None of those cleared for air travel was known to have experienced a significant in-flight medical problem.

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Literature review current through: Nov 2017. | This topic last updated: Sep 16, 2016.
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