Pneumothorax history Disqualifying?

[Guest Aviator85]

I have had 2 pneumothoraxes 3 years apart. Will this be a problem down the road?

[Guest F16PilotMD]

Yes, this is most definitely a problem. You require a waiver for just ONE spontaneous pneumothorax. I can't find any info about recurrent pneumothoraces. You will need documentation, chest xrays, chest CT scans, etc...whatever was done. You will also need reports from the physicians that took care of you. Specific diagnosis, treatment(s), etc. Without any definitive treatment, this has a very, very high liklihood of happening again and again.

If you are close to applying to the ANG or AFRES, I would start this process soon. You will be a lot of work for the flight docs. That's okay...as far as I'm concerned that's why we're here...but you need to get all your 'ducks in a row' as far as documentation, etc for them.

AFI48-123:

A7.16.2. Flying Classes I and IA. In addition to the above:

A7.16.2.1. History of spontaneous pneumothorax. A single episode may be considered for waiver

after 3 years if pulmonary evaluation shows complete recovery with full expansion of the lung and

no demonstrable pathology that would predispose to recurrence.

Good Luck.

WAIVER GUIDE:

CONDITION: PNEUMOTHORAX

I. Overview. Spontaneous pneumothorax is best defined as “air in the pleural space of nontraumatic cause.” Secondary spontaneous pneumothorax is one that occurs in the presence of underlying parenchymal or airway disease, and for aviation purposes will not be considered further. Primary spontaneous pneumothorax, by default, is one that occurs in the absence of such underlying disease. However, it would be incorrect in such cases to define the lung as normal, since the vast majority prove to have visceral subpleural blebs at thoracoscopy. Primary spontaneous pneumothorax typically peaks in the 16 to 24 year age group, affecting males about 5 to 10 times more frequently than females. Although the incidence in the general population is usually quoted as 9 per 100,000, the real incidence is probably higher. In most large series, 1 to 2% are incidentally found on chest film; since small pneumothoraces resolve themselves themselves within a few days, the odds of identifying an asymptomatic pneumothorax in this way are slim, arguing that the disease is probably more common than thought.

A specific subcategory that deserves mention is catamenial pneumothorax. This is a spontaneous pneumothorax occurring in a female within 48 to 72 hours of the onset of menses. Although these are often ascribed to endometriosis, pleural endometrial implants have been identified in only a third of patients. It is important to question any female with a spontaneous pneumothorax about the timing in relationship to menses, since the initial treatment of catamenial pneumothorax is hormonal. Should the patient fail a trial of contraceptive steroids, this disorder responds well to the same prophylactic surgical treatments described below.

Depending on the size of the pneumothorax, acute treatment may consist of observation, usually combined with oxygen, which hastens resolution; simple aspiration of the air, which is successful about 65% of the time; or catheter or tube thoracostomy. (Since these are usually “air only” pneumothoraces, a small catheter with a Heimlich valve is usually successful, and much more comfortable than a standard chest tube.)

The major issue is recurrence. After an initial pneumothorax, the chance of recurrence is 20 to 50%, a risk which rises after subsequent episodes. (After two pneumothoraces, the risk of a third is 62%; of those who have had three episodes, 83% will have a fourth.) The clinical standard care for a number of years has been to perform a definitive surgical procedure after the second pneumothorax, but with the availability of thoracoscopic pleurodesis, there are many who feel that surgery is indicated after the first episode, particularly in those who are at high risk because of their occupation or because of travel to remote areas.

II. Aeromedical Concerns. The most likely symptoms are chest pain and dyspnea, either of which could be incapacitating. In a review by Voge and Anthracite of 112 aviators with spontaneous pneumothorax, 37% admitted they could have been incapacitated had the episode occurred during flight. Overall, seventeen percent of the episodes occurred under operational conditions. Eleven percent actually occurred during flight, although it was unclear how many of these resulted in mission aborts. Of note, another 6% occurred in the altitude chamber, and all but one of those occurred after rapid decompression.

III. Information Required for Waiver Submission. After complete resolution of a first episode of pneumothorax, the aviator may be returned to flying status without waiver, if a high resolution CT scan demonstrates no pathology, such as blebs or underlying parenchymal disease, which might predispose to recurrence. After a second pneumothorax, or if CT demonstrates residual blebs, waiver may be considered only after definitive surgery to prevent recurrence.

IV. Waiver Considerations. The ACS has recently reviewed the available literature regarding definitive treatment of spontaneous pneumothorax. Thoracoscopic abrasive pleurodesis appears to be the procedure of choice, with minimal morbidity and a recurrence rate under 5%. Open pleurodesis showed a similar recurrence rate, but is accompanied by greater morbidity. Pleurectomy, whether through thoracotomy or thoracoscopy, offered no additional benefit, at the cost of additional morbidity. Talc poudrage showed variable results, but the only sizable series demonstrated a recurrence rate of 12%. Furthermore, talc administration has some inherent disadvantages, such as the long term risk of pleural fibrosis, which renders its use questionable in the relatively young aviator population. Chemical pleurodesis with tetracycline or similar compounds results in an unacceptable rate of recurrence.

In summary, any form of definitive surgical pleurodesis is acceptable for waiver, but thoracoscopic abrasive pleurodesis appears to offer the best combination of efficacy and minimal morbidity. Chemical pleurodesis with tetracycline compounds is not acceptable for waiver. Talc pleurodesis is definitely not recommended, due to borderline efficacy and the risk of long term complications.

[Guest Dee]

i know this thread is quite old but was wondering if anyone can point me in the right direction for getting in contact with someone. i had a sinlge occurrence of this happen to me in 06, but have been flying for a living since then with no problems. i have also had no problems getting my faa class 1 medical. i'm in the process of trying to join the reserves as a boom operator at the unit i would like to fly with later down the road and just would like to know if this might put a damper on it.

thanks de

[Guest Dee]

well my recruiter just said that meps won't take me till three years after the occurrence, anyone know of any better outcomes than mine?

[Guest P27:17]

well my recruiter just said that meps won't take me till three years after the occurrence, anyone know of any better outcomes than mine?

Damn...I wish I had posted the AFI's on my personal computer...I'll check on this...even if the "3 year rule is correct" a single spontaneous PT is very waiverable...I'll get back to you...

[Guest F16PilotMD]

Dee, if you want to be a boom, I believe you will be okay. I'm in the fighter world, but I think a boom is a class III. See below:

A4.17.1.2. History of spontaneous pneumothorax (512). A single episode of spontaneous pneu-

mothorax does not require waiver if PA inspiratory and expiratory chest radiograph and thin-cut

CT-scan show full expansion of the lung and no demonstrable pathology which would predispose

to recurrence.

Edited October 20, 2008 by F16PilotMD

[Guest Dee]

Dee, if you want to be a boom, I believe you will be okay. I'm in the fighter world, but I think a boom is a class III. See below:

A4.17.1.2. History of spontaneous pneumothorax (512). A single episode of spontaneous pneu-

mothorax does not require waiver if PA inspiratory and expiratory chest radiograph and thin-cut

CT-scan show full expansion of the lung and no demonstrable pathology which would predispose

to recurrence.

thanks guys, looks like i'll try and find someone else in the area that's willing to work with me

:-)

[LookieRookie]

Currently on flying status and just had a spontaneous pneumothorax. Any new information on this? 

[deaddebate]

G14 - History of spontaneous pneumothorax. NOTE: A single episode of spontaneous pneumothorax does not require waiver if the condition has completely resolved, PA inspiratory and expiratory chest radiograph and thin-cut CT-scan show full expansion of the lung and no demonstrable pathology which would predispose to recurrence.

You'll need some work-up, but hopefully you'll be good to go after about 2 weeks DNIF.

[LookieRookie]

1 hour ago, deaddebate said:

You'll need some work-up, but hopefully you'll be good to go after about 2 weeks DNIF.

Sweet I appreciate it!

[tlaw99]

I could not find any waiver reference to surgical or traumatic pneumothorax. Would it follow the same waiver steps as a spontaneous pneumothorax?