Freediving after a Pneumothorax

In SCUBA Diving, an spontaneous pneumathorax is under most circumstances an reason to disqualify someone for diving. The reason is that people who have might experienced as such an event might be susceptible to another one, which in turn is deadly if it would happen underwater.

In my knowledge, the risks of an recurrence of an spontanious pneumothorax in freediving, combined with an tension pneumothorax, other then the elsewhere mentioned pneumomediastinum, is unkown.

What also might help in investigating if your friend could safely resume freediving is to know the type of operation and the findings. This should be discussed with a diving physican with specific knowledge of lung pathology, or an pulmonologist with an diving physican license.

I agree, its a strong contraindication
I would consult a pneumologist with specialisation in Diving Medecine.
As Rik said the type of operation (VATS vs. open) and the physical constitution (Smoker/COPD) have a progostic impact. Medscape: "The 5-year recurrence rate is 28-32% for primary spontaneous pneumothorax (PSP) and 43% for secondary spontaneous pneumothorax (SSP). Recurrences are more common among patients who smoke, patients with chronic obstructive pulmonary disease (COPD), and patients with acquired immunodeficiency syndrome (AIDS). Predictors of recurrence include pulmonary fibrosis, younger age, and increased height-to-weight ratio."

If he would decide to continue freediving after evaluation I would suggest individualised exercices to increase thoraic and lung flexibility for instance (YOGA,..., as well as massage of thorax and of course no increase in depth. This will result in greater compliance of the thorax/lungs thus probably decreasing injury risk. I'm simply writing this because I know that people do what they want to do and not what we tell them to do, especially doctors themselves. So if he continues to dive he should at least make sure that he takes all the measures possible to decrease risk. Freediving should be classified as an addiction anyways
I guess one could only really find out what happens to his lung with a CT in a hyperbaric chamber. But that doesn't exist to my knowledge.

O.K. here goes my story:

I suffered spontaneous pneumothorax (out of blue) 6 years ago at age of 34 with my left lung collapsing 85%. I was treated with drain tube insertion and released from hospital 2 days later as my lung got back up 100%. I was recommended to undergo abrasion pleurodesis surgery if I wished to dive ever again. It was a massive deal for me as diving was a big part of my job so I started taking all preparatory steps. However, to my BIG disappointment, I found out no doctor in the world would ever signed off any S.P. sufferer for SCUBA ever again, regardless of having surgery or not. Since then I simply won't pass SCUBA dive medical, full stop, for as long as I keep ticking S.P. box on medical exam form. Facing this reality I had several more second opinions about the surgery and decided it wasn't worth it. I had a couple of CT scans to see if there were any abnormalities (blebs) on both lungs that could obviously cause another S.P. and they found none. The next on agenda was my freediving/spearing and this wasn't found to be a problem, since ambient pressure after surfacing won't cause as much damage as expanding compressed air (tension pneumothorax). As one physician pointed out, if there were any weak spots (blebs) on lungs, repetitive expanding and contracting during freediving could actually be a factor for S.P. reoccurrence, however it shouldn’t be fatal. For this reason I was told I do still pass my dive medical exam for breath hold diving only (through an official dive doctor) and I’m able to free dive on my job. I started to freedive 3 months after the accident, dive a lot and so far had no problems at all (I don't pack and do exhale apnea though). The main issue is in the fact, no one knows exactly why S.P. does occur in the first place (if there is no presence of underlying disease) and therefore can’t say whether or not it may happen again and when, and that’s the risk no doctor would ever take.

Very keen to hear about how is your friend going William. Cheers.