If a patient has two spontaneous pneumothoraxes on the same side and they have not been treated, what is the appropriate action?

A patient who has experienced two spontaneous pneumothoraxes on the same side without treatment poses significant health risks, particularly in the context of operating a commercial vehicle. Spontaneous pneumothorax, which occurs when air leaks into the space between the lung and chest wall, can lead to serious complications, including respiratory distress and the potential for sudden impairment while driving.

Given the potential for recurrence and the critical nature of respiratory function for commercial drivers, the safest decision is to disqualify the individual from driving. This decision is based on the understanding that an untreated condition with this history greatly increases the likelihood of a medical emergency that could jeopardize not only the driver's safety but also the safety of others on the road.

While other options such as conditional certification or issuing a 1-year certificate might seem less restrictive, they do not adequately address the immediate health concerns associated with multiple pneumothoraxes. Therefore, disqualification is the most prudent and responsible choice in this scenario.