Pneumothorax After Air Travel in Lymphangioleiomyomatosis, Idiopathic Pulmonary Fibrosis, and Sarcoidosis

doi:10.1378/chest.08-3034

Chest

Volume 136, Issue 3, September 2009, Pages 665-670

https://doi.org/10.1378/chest.08-3034 Get rights and content

Background

The prevalence of pneumothorax associated with travel in patients with interstitial lung diseases is unknown. In patients with lymphangioleiomyomatosis (LAM), in whom pneumothorax is common, patients are often concerned about the occurrence of a life-threatening event during air travel. The aim of this study was to determine the prevalence of pneumothorax associated with air travel in patients with LAM, idiopathic pulmonary fibrosis (IPF), and sarcoidosis.

Methods

Records and imaging studies of 449 patients traveling to the National Institutes of Health were reviewed.

Results

A total of 449 patients traveled 1,232 times; 299 by airplane (816 trips) and 150 by land (416 trips). Sixteen of 281 LAM patients arrived at their destination with a pneumothorax. In 5 patients, the diagnosis was made by chest roentgenogram, and in 11 patients by CT scans only. Of the 16 patients, 14 traveled by airplane and 2 by land. Seven of the 16 patients, 1 of whom traveled by train, had a new pneumothorax; 9 patients had chronic pneumothoraces. A new pneumothorax was more likely in patients with large cysts and more severe disease. The frequency of a new pneumothorax for LAM patients who traveled by airplane was 2.9% (1.1 per 100 flights) and by ground transportation, 1.3% (0.5 per 100 trips). No IPF (n = 76) or sarcoidosis (n = 92) patients presented with a pneumothorax.

Conclusions

In interstitial lung diseases with a high prevalence of spontaneous pneumothorax, there is a relatively low risk of pneumothorax following air travel. In LAM, the presence of a pneumothorax associated with air travel may be related to the high incidence of pneumothorax and not to travel itself.

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Study Population

The population comprised 281 subjects with LAM (National Heart, Lung, and Blood Institute [NHLBI] protocol 95-H-0186), 76 patients with IPF (NHLBI protocols 99-H-0056, 99-H-0068, and 04-H-0211), and 92 patients with sarcoidosis (NHLBI protocols 82-H-0032, 96-H-0100, and 06-H-0072) who were admitted to the NIH Clinical Research Center, a research hospital where patients are enrolled in research protocols. Protocols allowed us to perform CT scans and chest roentgenograms, and to publish findings.

Demographics

Table 1 shows the clinical and physiologic characteristics of the 449 patients. All LAM patients were female; 240 were white, 18 were Asian American, 17 were African American, 4 were Hispanic, and 2 were from Pacific islands. The diagnosis of LAM was established by tissue biopsy in 169 patients and CT scan findings in 112 patients. One hundred forty patients had a history of pneumothorax, and 122 had undergone pleurodesis.

Twenty-three of the IPF patients were female and 53 were male.

Discussion

In this retrospective study of 449 patients with interstitial lung diseases who traveled to the NIH from within the United States, Canada, and other parts of the world, we found evidence of recent pneumothorax potentially associated with travel only in patients with LAM. Among 281 LAM patients, 7 had evidence of a new pneumothorax. However, because pretravel radiologic imaging was not available and none of the seven patients with a pneumothorax experienced symptoms of dyspnea or chest pain

Acknowledgments

Author contributions: Drs. Taveira-DaSilva and Moss were responsible for writing the manuscript. Dr. Burstein and Ms. Hathaway collected and organized the demographic data for the LAM patients. Drs. Fontana and Gochuico performed the studies and organized the data for the sarcoidosis and IPF patients, respectively. Dr. Avila read the CT scans of the patients.

Financial/nonfinancial disclosures: The authors have reported to the ACCP that no significant conflicts of interest exist with any

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Funding/Support: This research was supported by the Intramural Research Program of the National Heart, Lung, and Blood Institute and the National Human Genome Research Institute, National Institutes of Health.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

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