Spontaneous Pneumothorax disables you for diving forever or not ?

[marcusbcn]

Dear Scuba Divers,

This is my first post on the board. I actually have dived only twice, for 30 minutes or so each time, but got really really hooked to scuba diving. Can't wait to do more. I would like to go for PADI Open Waters as soon as possible.

However ....

I had a spontaneous pneumothorax 13 years ago. They didn't do me any special chirurgical operation besides puncturing the torax and draining the air. That's it. I never had any pneumothorax again in my life. Nor any lung problems that I am aware of. I quited smoking 1 year ago (I've been a smoker for the last 6 years).

I've looked on the internet and in this board and I am still unsure if I am "totally disabled" for diving or not. Some people on this forum say that is better to not dive if you ever had one. Some reputable websites I found on this board say that if you never had a recurrence in 5 years after your first SN you have the same chances to have one than any person who never had one.

I know this has been asked before but I can't manage to find a straight, clear answer.

Considering I never had a recurrence in 13 years (I am 32 now) and if I do a CT scan and the lungs are ok (no bullae or anyother problem) would I be able to dive ?

Of course I would go to a specialized doctor before but they are expensive and I would like to know first if it's worth spending the money on the CT Scan and the doctor appointment.

Well, many thanks in advance.

All the Best,
Marcus

 

[DocVikingo]

Hi Marcus,

The short answer is, yes, spontaneous pneumothorax generally is an absolute contraindication to scuba.

I suggest you start by reading the following:

By DAN

DAN | Medical Frequently Asked Questions

By Scubadoc

Pneumothorax

Regards,

DocVikingo

 

[CamC]

Hi Marcus,

DocVikingo is right, of course, but the operative word is "generally". A single event, in the teenage years, is not an absolute contraindication. For your own peace of mind, though, if nothing else, you should get every test going so that a doctor specialising in dive medicine can make an individual assessment. You have to be happy yourself that the risk - however small - is acceptable to you; if you spring a leak at depth it will not end well, so it is money well spent either way! Oh, and be prepared to produce an updated "doctor's note" annually for training with most agencies, even though the risk technically diminishes further as time passes. I had a single spontaneous pneumothorax 33 years ago and am off for my own annual check-up next week.

 

[marcusbcn]

Hi Marcus,

The short answer is, yes, spontaneous pneumothorax generally is an absolute contraindication to scuba.

I suggest you start by reading the following:

By DAN

DAN | Medical Frequently Asked Questions

By Scubadoc

Pneumothorax

Regards,

DocVikingo

Hi DocVikingo,

Thanks for your answer.

I have checked those links. They provide the classical "mantra" : spontaneous pneumothorax = don't dive anymore.

However, I've found other (reputable?) sources that state if you haven't had a recurrence on the last 5 years and are unoperated, chances are minimal and not greater than those of the general population. See :Pneumothorax and Diving

Recurrence rates after recovery from a first spontaneous pneumothorax are high (-50%), are more commonly ipsilateral than contralateral but are very infrequent after intervals of two years or more. The medical committee has therefore adopted the pragmatic approach of accepting that in individuals with a history of spontaneous pneumothorax who have had a bilateral pleurectomy or who are unoperated upon but had no pneumothorax for five years the risk of pulmonary barotrauma is small and not significantly greater than for many in the general population e.g. smokers. Such individuals may dive provided that a CT scan of the chest and lung function tests, including flow-volume loops, show no reason to suggest that there is significant residual lung disease.

What do you think about that ?

 

[marcusbcn]

Hey CamC,

Thanks for your answer. What do you think about my answer to DocVikingo ?

It states that I won't have more risk than that of the general population. So provided a spiral CT scan is ok, why should I be more worried than anyone else ?

Thanks,
Marcus

EDIT : Well, the post i replied to DocViking is awaiting moderation. Probably because it has a link on it. So wait until it's visible.

 

[DocVikingo]

Hi DocVikingo,...See neumothorax and Diving ... What do you think about that ?

Hey Marcusbcn,

I think that you make a good, and supported, point--I was merely directing you to some respected, authoritative sources.

Perhaps it boils down to the fact that once one has had a spontaneous pneumothorax, one's risk of recurrence, operated or not, appears to decrease over time, but nonetheless still does not reach that of the general population that is without other risk factors, e.g., smoking. And, a recurrence u/w has an extremely high likelihood of death.

CamC said, "You have to be happy yourself that the risk - however small - is acceptable to you; if you spring a leak at depth it will not end well, so it is money well spent either way!" While I find this comment not without merit, I would add that your wife, children, other family, dive partner & dive op, to name a few, should also find this acceptable.

As CamC wisely suggested, should you decide to proceed a high-resolution spiral/helical CT scan of the chest, pulmonary functions tests, including flow-volume loops, should all be within normal limits, and you should receive specific clearance to return to scuba from a diving savvy pulmonologist or the like.

Thanks for the informative & respectful discussion.

Cheers,

DocVikingo

 

[marcusbcn]

Perhaps it boils down to the fact that once one has had a spontaneous pneumothorax, one's risk of recurrence, operated or not, appears to decrease over time, but nonetheless still does not reach that of the general population that is without other risk factors, e.g., smoking. And, a recurrence u/w has an extremely high likelihood of death.

Hey Doc, really, that bad ??? It sounds dramatic.

I've asked an hiperbaric doctor here in Spain and he said if the spiral CT is clear, and all the other tests are OK, I could dive. However I wanted to know an opinion from foreign doctors like you. Enough caution is never enough with these things.

Anyway, the spiral CT scan is supposed to detect bullae as small as 2mm (0.07 inches).

 

[DocVikingo]

Hey Doc, really, that bad ??? It sounds dramatic.

Well, given the specifics of this case I personally don't think the risk of recurrence is dramatic, or even "that bad", but I do think that death is : )

Cheers,

DocV

 

[TSandM]

I did a literature search for the ability of a negative CT to predict risk of recurrence in spontaneous pneumothorax, and came up empty-handed. But I did find a Japanese study where they looked at CT results versus the findings of blebs intraoperatively, and the CT had a 15% false negative rate. That means that in 15% of the patients, the CT said there would be no abnormalities in the lung, but the surgeons found them when the chest was opened. Now, the presence of blebs does not directly predict spontaneous pneumothorax, but certainly, one would have to believe that the risk is higher in patients who have them.

When you talk to physicians about "clearing" you for diving, you are asking the doctor to certify that nothing bad will happen to you as a result of the activity. We are very reluctant to do that without data, especially in the face of a known issue that could be fatal. Is your risk of spontaneous pneumothorax today massively higher than that of the general population? Probably not. Can a CT assure us that there is no abnormality in your lung now? Clearly, the study says no. If you were to dive, and die of a pneumothorax, would your family consider suing the physician who gave you "clearance" to dive? I don't know what it's like in Spain, but they'd sure consider doing it here, especially since it's extremely easy to find references recommending that patients who have had spontaneous pneumos not dive.

Because diving deaths impact instructors, dive operators, insurance companies, and physicians, those groups tend to be quite risk-averse. You may be willing to accept the risk of a bad outcome for yourself, but the agency, instructor and dive op may not be willing to participate in that decision.

I suspect you are right, that at some point the risk of recurrence drops to close to that of the general population. But absent enough studies to prove it definitively, and a change in guidelines from the major organizations who discuss diving risk, I think you will find it difficult to come up with a physician who will sign you off for a scuba class. I'm sorry.

 

[CamC]

Doc and TS&M have already covered most of what I would have said to you. I can only reiterate that I made my own personal decision to start - and keep on - diving only after assuring myself and my family that as far as it is possible to tell after a barrage of tests my lungs are no more likely to experience a pneumothorax than the next person's. There is no denying, however, that the biggest single predictive factor is a previous event, more so even that smoking. Also, in my UK-based case, I was lucky to know a local doctor with specialist dive knowledge who was very well acquainted with BSAC literature and guidelines, which are slightly less rigid than some. At the end of the day, though, his signature on my annual review is just his opinion, not a guarantee, and it is understood as such by all parties. I always disclose the situation fully each time I go diving, and I haven't found an operator yet who has turned me away.