What is pneumothorax?

Pneumothorax is the medical term for a collapsed lung. This occurs when air is present in the space between the lungs and the rib cage, which is known as the pleural space. This causes a loss of lung volume, as the pressure that keeps the lungs inflated is disrupted by air accumulating in the pleural space.

Air within the pleural space can come from the lung itself, or from outside of the body if there has been a serious injury to the chest. It is more common in people with a chronic lung condition, such as asthma or cystic fibrosis, but it can occur in anyone. It can affect young and tall patients.

What can cause pneumothorax?

Patients with this condition are classified into two categories: traumatic pneumothorax and non-traumatic pneumothorax.

Traumatic pneumothorax results from an injury to the chest or the lung wall. Such injuries could occur after a motor vehicle accident, from broken ribs or after a hard hit to the chest playing contact sports.

Non-traumatic pneumothorax occurs spontaneously, and can occur in people with no history of lung problems. This is referred to as primary spontaneous pneumothorax. On the other hand, when the condition occurs in patients with a history of lung problems or disease, it is referred to as secondary spontaneous pneumothorax. Older people, especially those with pre-existing lung problems, are more prone to developing pneumothorax.

What are the symptoms of pneumothorax?

The main symptoms of pneumothorax are:

shortness of breath
rapid breathing
tightness or an ache in the chest
stabbing chest pain that is worse when breathing in
a very fast heart rate (severe tachycardia)
blue-tinted skin, caused by a lack of oxygen
fatigue
a dry cough

If caused by injury, symptoms of pneumothorax can occur at the time or shortly after the traumatic incident. In cases of spontaneous pneumothorax (primary or secondary), symptoms can first present when at rest.

Who is most at risk of pneumothorax?

Although anyone can be affected by primary spontaneous pneumothorax, some people are more prone to the condition. Most often, primary spontaneous pneumothorax affects tall, thin men under the age of thirty. The following factors may also make a person more likely to develop pneumothorax:

smoking
engaging in activities, such as scuba diving and high-altitude flying
poor nutrition, which may result from an eating disorder, such as anorexia

Secondary spontaneous pneumothorax occurs as a complication of various other conditions. Patients suffering from lung diseases, such as the following, are more prone to developing pneumothorax:

chronic asthma
cystic fibrosis
tuberculosis
chronic obstructive pulmonary disease (COPD)
pertussis
lung cancer
interstitial lung disease
pneumonia

Connective tissue diseases can also make a person more likely to develop pneumothorax. This may include:

Ruptured air blisters, which can develop on top of the lung, can also cause air to leak into the pleural space. Additionally, mechanical ventilation, such as breathing assistance machines, can also cause pneumothorax.

Traumatic pneumothorax is caused by an injury to the chest area, such as broken ribs or a hard hit to the chest. People who engage in extreme or contact sports may be more likely to sustain such an injury than others.

How is pneumothorax diagnosed?

A stethoscope can pick up changes in lung sounds during a physical examination, and you will also be asked about your medical history and symptoms. To make a definitive diagnosis of pneumothorax, some testing, such as a chest X-ray, CT scan or ultrasound may be required.

Does pneumothorax always require treatment?

It is important to seek urgent medical attention if you experience any of the symptoms of pneumothorax, so your condition can be properly assessed and the best form of treatment can be determined, if necessary.

The treatment of pneumothorax depends on the individual person and the severity of their condition. Pneumothorax can either be large or small, and while small pneumothorax may resolve itself over time, more severe cases always require treatment.

How is pneumothorax treated?

Observation is recommended for those with small pneumothorax, and the doctor will monitor the patient on a regular basis. There will also be frequent X-rays to assess any progress, and to show if the lungs expand again.

Depending on the amount of air present and the degree of compression exerted on the lung, a combination of rest and another form of treatment may be prescribed.

In some cases, a flexible chest tube, which is attached to a one-way valve device, may be inserted to allow air evacuation. This can take several days and needs to be monitored by doctors. Thus, patients usually have to stay over several nights in hospital.

Alternatively, needle aspiration may be used to remove the excess air. In this form of treatment, a hollow needle with a small catheter tube attached is inserted between the ribs into the affected area. The doctor is then able to extract the excess air, allowing the lung to re-expand. Observation may be required for some time after this treatment to ensure that the problem does not recur.

Some patients are also provided with supplemental oxygen which can lessen symptoms and allow the body to reabsorb the oxygen from the pleural space, allowing the lungs to expand as normal. If these treatment methods are not successful, surgery may be necessary to resolve the issue.

When is surgery required?

In some cases, surgery is necessary to close any air leaks so that the lung is able to re-expand. Patients who have recurring cases of pneumothorax may require surgery to permanently treat the condition and prevent future problems.

There are several types of surgery used to treat pneumothorax, which may be combined to help prevent future recurrences. However, this is largely dependent on the cause behind the problem. The principle form of surgery is called a thoracoscopy, where the surgeon creates an incision in the pleural space to see the problem. A video-assisted thoracic surgery (VATS) is a similar procedure in which the surgeon inserts a small camera through the chest wall to be able to see inside.

Further types of surgical treatment may include:

Repairing any ruptured blisters or closing any air leaks.
Removing some or all of the lining that adheres to the chest wall (pleurectomy). This allows the lung to get stuck to the chest wall, reducing the risk of further collapse.
Peurodesis, a procedure in which inflammation is provoked to help the lung stick to the chest wall.

What is recovery like following treatment for pneumothorax?

It usually takes one or two weeks to recover after pneumothorax. and you will likely need to be monitored at regular intervals to ensure there are no recurring issues. Patients who have undergone surgery to treat pneumothorax may need longer to recover. It is important to make a gradual return to normal activities and not to overexert yourself at first.

There are a number of measures patients can take to ensure they make a sound recovery following pneumothorax:

Perform breathing exercises as instructed by your doctor, known as incentive spirometry.
Avoid intensive exercise and contact sports
Engage in low-impact and gentle exercise
Monitor symptoms and report pain, fever, or coughing up blood to your doctor
Avoid exertion of lifting heavy objects
Do not fly without the permission of your doctor (usually possible between three and 12 weeks after)
Do not go 7,000 feet above sea level

Can pneumothorax recur?

In many cases, patients who have suffered pneumothorax make a full recovery and do not go on to have further related health problems. Spontaneous pneumothorax can recur in up to fifty per cent of people, but this is largely dependent on the cause of the condition. Recurrent pneumothorax may mean that surgery is required to permanently solve the problem that is causing the repeated lung collapse.

What type of doctor treats pneumothorax?

Specialists in pulmonary and respiratory medicine and thoracic surgeons treat pneumothorax.