Updated 2015 review of spontaneous pneumothorax: recommendations for patients

  Pneumothorax has a high recurrence rate, so patients need to be informed of the symptoms that indicate a recurrence of pneumothorax and the need for prompt consultation.  The BTS guidelines recommend that all patients should be seen in thoracic surgery 2-4 weeks after the initial onset of pneumothorax to review pneumothorax resorption, check for underlying lung disease, and for the need for further treatment. Patients may be considered for normal work and activities after symptoms have resolved. However, strenuous exercise and body collision exercises should be performed only after imaging suggests complete resolution of the pneumothorax.  Patients need to be informed that smoking cessation significantly reduces the recurrence of primary pneumothorax, with a relative risk reduction of approximately 40%, in order to help them successfully quit smoking. Although smoking cessation is the most effective way to reduce the recurrence of pneumothorax outside of clinical treatment, the success rate of smoking cessation in pneumothorax patients is low, with studies showing that more than 80% of patients continue to smoke for more than 1 year after a pneumothorax attack.  Because underwater activity increases the rate of pneumothorax recurrence, and because pneumothorax volume increases during ascent from diving, increasing the risk of tension pneumothorax, the BTS guidelines recommend that diving should be avoided for life in patients not treated with definitive methods (e.g., partial pleurodesis). For professional divers, treatment such as partial pleurectomy is required after a pneumothorax attack before diving can be resumed.  Although airplane travel itself does not increase the risk of pneumothorax, it can aggravate the condition of pneumothorax at high altitude with serious consequences, so patients with pneumothorax without closed chest drainage should avoid airplane travel and should only travel after treatment or imaging data suggesting the disappearance of pneumothorax absorption.  For patients with previous pneumothorax, the decision to fly should be based on the likelihood of pneumothorax recurrence and the tolerance level of the pneumothorax attack. The UK Civil Aviation Authority allows pneumothorax patients to fly two weeks after successful treatment with closed chest drainage.