Returning to Flying Duties After a Pneumothorax
The Pilot’s Medical

Why does a pneumothorax
ground a pilot?

Because it can happen again, and because of where. Air trapped in the chest expands as cabin pressure falls with altitude, so a pneumothorax that recurs in flight can enlarge and compress the lung and the heart at the one moment when the pilot cannot leave the controls. After a first spontaneous collapse the chance of another is high, up to half of patients without definitive treatment, and it is concentrated in the first two years. The aeromedical rules are written around that risk, not around the original episode.

The rules therefore distinguish a pilot who has had one collapse treated by observation, needle aspiration or a chest drain, where the risk of recurrence remains, from a pilot who has had an operation that seals the lung to the chest wall, where it does not. Draining the collapse treats the episode; only the operation changes the category. The treatment of the collapse itself is on the pneumothorax page, and the rules for flying as a passenger on the flying after a collapsed lung page.

What do the CAA and EASA require before a
Class 1 or Class 2 medical is restored?

A spontaneous pneumothorax makes the applicant unfit. For a Class 1 (commercial) pilot treated without surgery, a fit assessment may be considered one year after full recovery, or at revalidation six weeks after full recovery with a multi-pilot limitation, which the CAA guidance keeps in place for at least a year because of the risk of recurrence. A Class 2 (private) pilot may be assessed six weeks after full recovery. A recurrent spontaneous pneumothorax that has not been treated surgically is disqualifying. The UK rules are retained from the EASA regulation and the wording of the two is the same (AMC1 and AMC2 MED.B.015, paragraph (f)).

Source: UK Civil Aviation Authority, respiratory guidance material and AMC1/AMC2 MED.B.015(f), read 28 October 2026; EASA Acceptable Means of Compliance to Part-MED, AMC1 and AMC2 MED.B.015(f). The fitness decision is the aeromedical examiner’s and, for Class 1, the CAA medical assessor’s. This page summarises the published rules; it does not replace them, and they change.

Does definitive surgery change
the certification timeline?

Yes, in two ways. For a Class 1 pilot it removes the multi-pilot limitation: without surgery the choice is a year with the limitation or a year off; after an accepted operation, unrestricted certification can be considered six weeks after full recovery with a normal chest X-ray. And it removes the risk that a second collapse makes the pilot unfit altogether, since a recurrent pneumothorax that has not been treated surgically is disqualifying.

The operation must be one the authority accepts. The CAA guidance lists thoracotomy, oversewing of apical blebs and parietal pleurectomy, with recertification six weeks after a VATS pleurectomy, and states that chemical pleurodesis is not acceptable. A pilot offered talc pleurodesis, which is a common treatment for other patients, should raise this before the procedure. The choice of operation decides whether an unrestricted medical can follow, and it is agreed at the consultation, before surgery, with the certification route in view.

There is no requirement to operate immediately. Once the lung has re-expanded there is usually no clinical urgency, and the operation can be planned around rosters, leave and travel. What should not be left is the decision itself, because the clock for certification runs from full recovery, whichever route is taken.

What operation is done, and what is
the recurrence rate after it?

Dr Okiror performs a keyhole (VATS) apical resection with complete parietal pleurectomy and abrasion of the diaphragm. The weak area at the top of the lung where the air leaked is removed, and the lining of the chest wall is stripped so that the lung heals to it and cannot collapse again. Recurrence after pleurectomy is well under one per cent. Keyhole talc or abrasion pleurodesis on its own has a recurrence rate of around five to ten per cent, and talc is not accepted by the CAA for aircrew in any case.

The operation is done through small incisions under general anaesthetic. Most patients spend a few days in hospital while the chest drain is in and the lung seals; the drain is almost always removed before discharge. A chest X-ray before you leave and at the post-operative review confirms that the lung is fully expanded, and that X-ray is part of what the aeromedical examiner needs. A CT scan is done before the operation to look for blebs on either side.

Where blebs are found on both sides, or where the pilot has had a collapse on each side, treating both sides is discussed at the consultation. The surgery itself, and recovery week by week, are on the pneumothorax and recovery pages. Where a collapse runs in the family, the genetic causes page explains what is tested for.

What does the FAA
require?

The FAA Guide for Aviation Medical Examiners lists spontaneous pneumothorax as a condition that requires an FAA decision rather than issue by the examiner. A single episode is disqualifying until there is X-ray evidence of resolution and it has been established that no condition prone to recurrence, such as residual blebs, is present. A pilot who has had a repeat pneumothorax is generally not certified until the underlying problem has been surgically corrected, after which return to duties is usually about three months after surgery, with no special altitude limitation. A traumatic pneumothorax can be issued by the examiner three months after resolution.

Source: FAA Guide for Aviation Medical Examiners, Item 35, Lungs and Chest: Pleura, last updated 24 September 2025, read 28 October 2026. Pilots certified by other authorities should check that authority’s standard; the surgical report Dr Okiror provides is written to be usable by any of them.

Cabin crew, air traffic controllers
and divers

Cabin crew and air traffic controllers are assessed under their own medical standards, which are not the pilot rules on this page. The clinical question is the same, whether the risk of a further collapse has been removed, and the specialist report is provided in the same way for the examiner to apply the relevant standard. Tell Dr Okiror which certificate you hold at the consultation.

Diving is governed by separate standards and the required operation is different: a bilateral pleurectomy. Pilots who also dive, and anyone whose work involves diving, should read the diving after a collapsed lung page and, for the UKDMC, BTS, HSE and military standards side by side, the fitness to dive clinical reference.

How quickly can surgery be arranged
for a pilot based abroad?

Pilots whose collapse happens on a layover or at an overseas base contact the practice from where they are. Dr Okiror reads the X-rays and CT himself, a video consultation follows within 48 hours of the images arriving, and a written opinion within 48 hours of the consultation. Once the lung has re-expanded there is usually no clinical urgency, so the common pattern is to recover where you are, fly home as a passenger once a chest X-ray shows full re-inflation and a further seven days have passed, and have the operation in London at a planned date with the team that will write the aeromedical report.

Surgery is usually within a week of completing investigations, and a pilot who already has a CT can be booked within days of the consultation. After the operation the earliest flight home is one week after the chest drain is removed; a ferry or train journey can be taken earlier. The post-operative review, with the chest X-ray, is the point at which the specialist report is written, and it can be done by video with the X-ray taken locally if you have already travelled home. The two routes for patients outside the UK, the written quote and letters of guarantee are on the international patients page.

A pilot who is at home in the UK follows the same sequence without the travel: consultation within 2 to 3 days at London Bridge Hospital or The Lister Hospital Chelsea, CT, the operation, and the report after the post-operative review.

What does
it cost?

A new consultation is £250–£350. The guide price for keyhole bullectomy with pleurectomy at London Bridge Hospital is £12,000–£16,000, covering hospital, surgeon and anaesthetist fees for an uncomplicated stay. Hospital charges are the largest part of the total. The hospital issues a written quote after the consultation, and that quote is the figure that applies. All guide prices and how fees work →

Dr Okiror is recognised by AXA Health, Bupa, Aviva, Vitality, WPA and Cigna, and by Bupa Global, AXA Global and Cigna for pilots insured outside the UK. Insurers usually settle the hospital, surgeon and anaesthetist fees in full, less any excess written into the policy. A fee may apply for the specialist report to the aeromedical examiner or the authority; it is confirmed in writing when the report is requested.

Decide the operation
before the medical.

Appointments within 2–3 days at London Bridge Hospital or The Lister Hospital Chelsea, by video within 48 hours of your scans arriving if you are abroad. Self-referrals welcome. Dr Okiror reviews the imaging himself, agrees the operation with the certification route in view, and provides the report for your aeromedical examiner.

Jo Mitchelson, PA  · 020 7952 2882 · pa@lungsurgeon.co.uk

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