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PURPOSE: Without definitive intervention, individuals with an untreated pneumothorax should not participate in commercial flying. Whether this advice applies to patients with a long-standing pneumothotax is uncertain. We report two adults with persistent pneumothoraces who underwent further investigation to determine the safety of doing so.

METHODS: Following clinical assessment, both subjects had chest computerised tomographic (CT) imaging and underwent a hypoxic challenge test (breathing 15% oxygen). The individuals then proceeded to cabin altitude simulation in a hypobaric chamber.

RESULTS: Case 1--Chest CT showed a small left pneumothorax (estimated volume 110 millilitres). During a hypoxic challenge test, the oxygen saturation fell to 90%. During cabin altitude simulation, the patient remained asymptomatic and oxygen saturation fell to 90%. He was considered fit to fly and has completed over a dozen transatlantic flights without difficulty. Case 2--Chest CT showed a loculated right sided pneumothorax (estimated volume 250 millilitres) and during a hypoxic challenge test, the oxygen saturation fell to 93%. An altitude chamber test was tolerated without symptoms and the oxygen saturation fell to a minimum of 92%. She was therefore considered fit to fly in commercial aircraft.

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