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Lung diseases

Pilot with Lung Bullae

06/30/2010

Question:

I have just been told that i have a single lung bullae 10cm,on my right lung,i am an airline pilot does this disqualify me from holding a class 1 aviation medical license,and stop me from flying.

Answer:

A bullae is an air pocket within the lung. A 10 cm bullae is quite large. The danger is that if the bullae does not communicate with an airway, then when you ascend to high altitude, the bullae could enlarge to the point that it could compress the lungs and heart causing the pilot to pass out. If the bullae communicate with an airway, then it will decompress by exhausting air into the airway during rise to high altitude and not become dangerously enlarged.

In contrast to a bullae, a pneumothorax is an air pocket trapped between the lung and the ribs in the "pleural space". There is no communication with airway in this situation and pneumothoraces can enlarge to dangerously large sizes at higher altitudes.

One problem with bullae is that they do not always consistently connect to airways and even if there is a connection, then blockage by a plug of mucus or an inflamed airway can result in the bullae expanding at altitude.

This should be discussed with the physician who is authorized to do the pilot physical examination to determine if it precludes flying. Of course, the other concern is why the bullae is there in the first place and this may require additional testing.

Fortunately, bullae can be removed by a procedure called a bullectomy and this may be necessary in order to be completely sure that there is no danger of enlargement of the bullae in flight.

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Response by:

James N Allen, Jr, MD James N Allen, Jr, MD
Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University