**6. Pneumothorax and pregnancy**

Spontaneous pneumothorax during pregnancy is rare but not unusual [77, 78]. Notoriously pneumothorax recurs during pregnancy and poses risks to the mother

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pneumothorax.

*Controversies in Pneumothorax Treatment DOI: http://dx.doi.org/10.5772/intechopen.87141*

**7. Pneumothorax and air travel**

associated with air travel has been difficult to assess.

a bilateral parietal pleurectomy [81].

and foetus during labour. In addition, exposure to radiation of the X-rays in the first trimester is tied to foetal deformities and abnormalities. There is no unified evidence-based practice to guide management in this scenario. Historically it was managed by intercostal drainage for the rest of the pregnancy duration, thoracotomy at any stage, premature induction of labour or caesarean section. The clinician must be aware that even in the first trimester, the diaphragm moves cephalad approximately 4 cm. The classical landmarks for drain insertion do not apply. The most contemporary recommendation of management is a conservative approach. Expectant management is recommended if the mother is not dyspnoeic and there is no foetal distress and the pneumothorax on the chest X-ray is not significant (<2 cm). Symptomatic mothers could have needle aspiration or drain insertion to resolve the pneumothorax. There is no consensus as what to do with non-resolving pneumothorax, but in our centre, we tend to assess the risk in conjunction with the obstetrician's advice and perform a VATS bullectomy and partial parietal pleurec-

tomy. This is safe in the first trimester but should be avoided after that.

With regard to advice to the risk during labour, we adopt the one given by Lal et al. and the BTS guidelines [10, 79]. Elective-assisted delivery (forceps or ventouse extraction) at or near term is recommended, with regional (epidural) anaesthesia. Less maternal effort is required with forceps delivery, which theoretically reduces the chance of recurrence. Close cooperation between the respiratory physician, obstetrician and thoracic surgeon is essential, requiring delivery to be undertaken in a tertiary referral centre with all three specialties under one roof. If a caesarean section is unavoidable, then a spinal anaesthetic is preferable to a general anaesthetic. To avoid desaturation and tension during general anaesthesia, a prophylactic intercostal drain could be considered as a safety measure. It is advisable that the mother should undergo elective VATS procedure after convalescence due to the risk of recurrence in subsequent pregnancies.

Commercial air traffic is on the rise. The number of medical emergencies on-board aircraft is increasing as the age-increasing general population becomes more mobile and adventurous. Travellers with respiratory diseases are at particular risk for in-flight events. Exposure to lower atmospheric pressure in a pressurised cabin at high altitude may result in pneumothorax. Gas expansion within enclosed spaces in the human body could expand by 25–30% at the typical cruising altitude of a commercial airline flight, causing significant hypoxia. Patients at risk are those with bullae, cystic lung disease, lymphangioleiomyomatosis (LAM), pulmonary Langerhans cell histiocytosis, cystic pulmonary adenomatoid malformation (CPAM) and cystic bronchiectasis [80]. The currently available guidelines are admittedly based on sparse data and include recommendations to delay air travel for 1–3 weeks after thoracic surgery or resolution of the pneumothorax [80]. No fatalities have been reported due to pneumothorax on-board aviation generally; however, true incidence of specific illnesses

The diagnosis of pneumothorax can be career limiting in the US Air Force. Once an SP has been diagnosed in an individual, he/she will be grounded from further flight duties until either 9 years have elapsed without a recurrence or there has been

Barotrauma during or after scuba diving (also on the rise) can rarely lead to pneumothorax, especially on sudden ascent not allowing time for equilibrium. The data is sparse, and there is no solid recommendation about this sport in the literature. Snorkelling sport up to a depth of 10 m does not seem to increase the risk of
