Tuberc Respir Dis.  2014 Mar;76(3):99-104.

Pneumothorax

• Choi WI

Abstract

Pneumothorax-either spontaneous or iatrogenic-is commonly encountered in pulmonary medicine. While secondary pneumothorax is caused by an underlying pulmonary disease, the spontaneous type occurs in healthy individuals without obvious cause. The British Thoracic Society (BTS, 2010) and the American College of Chest Physicians (ACCP, 2001) published the guidelines for pneumothorax management. This review compares the diagnostic and management recommendations between the two societies. Patients diagnosed with primary spontaneous pneumothorax (PSP) may be observed without intervention if the pneumothorax is small and there are no symptoms. Oxygen therapy is only discussed in the BTS guidelines. If intervention is needed, BTS recommends a simple aspiration in all spontaneous and some secondary pneumothorax cases, whereas ACCP suggests a chest tube insertion rather than a simple aspiration. BTS and ACCP both recommend surgery for patients with a recurrent pneumothorax and persistent air leak. For patients who decline surgery or are poor surgical candidates, pleurodesis is an alternative recommended by both BTS and ACCP guidelines. Treatment strategies of iatrogenic pneumothorax are very similar to PSP. However, recurrence is not a consideration in iatrogenic pneumothorax.

Keyword

Pneumothorax; Pneumothorax, Primary Spontaneous; Plmonary Bullae Causing Pneumothorax

MeSH Terms

Chest Tubes
Humans
Lung Diseases
Oxygen
Pleurodesis
Pneumothorax*
Pulmonary Medicine
Recurrence
Thorax
Oxygen

Reference

1. Norris RM, Jones JG, Bishop JM. Respiratory gas exchange in patients with spontaneous pneumothorax. Thorax. 1968; 23:427–433.

2. Bense L, Eklund G, Wiman LG. Smoking and the increased risk of contracting spontaneous pneumothorax. Chest. 1987; 92:1009–1012.

3. Schramel FM, Postmus PE, Vanderschueren RG. Current aspects of spontaneous pneumothorax. Eur Respir J. 1997; 10:1372–1379.

4. Bense L, Wiman LG, Hedenstierna G. Onset of symptoms in spontaneous pneumothorax: correlations to physical activity. Eur J Respir Dis. 1987; 71:181–186.

5. Baumann MH, Strange C, Heffner JE, Light R, Kirby TJ, Klein J, et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest. 2001; 119:590–602.

6. Henry M, Arnold T, Harvey J. Pleural Diseases Group, Standards of Care Committee, British Thoracic Society. BTS guidelines for the management of spontaneous pneumothorax. Thorax. 2003; 58:Suppl 2. ii39–ii52.

7. MacDuff A, Arnold A, Harvey J. BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010; 65:Suppl 2. ii18–ii31.

8. Engdahl O, Toft T, Boe J. Chest radiograph: a poor method for determining the size of a pneumothorax. Chest. 1993; 103:26–29.

9. Phillips GD, Trotman-Dickenson B, Hodson ME, Geddes DM. Role of CT in the management of pneumothorax in patients with complex cystic lung disease. Chest. 1997; 112:275–278.

10. Kircher LT Jr, Swartzel RL. Spontaneous pneumothorax and its treatment. J Am Med Assoc. 1954; 155:24–29.

11. Chadha TS, Cohn MA. Noninvasive treatment of pneumothorax with oxygen inhalation. Respiration. 1983; 44:147–152.

12. Northfield TC. Oxygen therapy for spontaneous pneumothorax. Br Med J. 1971; 4:86–88.

13. Baumann MH, Strange C. Treatment of spontaneous pneumothorax: a more aggressive approach? Chest. 1997; 112:789–804.

14. Noppen M, Alexander P, Driesen P, Slabbynck H, Verstraeten A. Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax: a multicenter, prospective, randomized pilot study. Am J Respir Crit Care Med. 2002; 165:1240–1244.

15. So SY, Yu DY. Catheter drainage of spontaneous pneumothorax: suction or no suction, early or late removal? Thorax. 1982; 37:46–48.

16. Minami H, Saka H, Senda K, Horio Y, Iwahara T, Nomura F, et al. Small caliber catheter drainage for spontaneous pneumothorax. Am J Med Sci. 1992; 304:345–347.

17. Sharma TN, Agnihotri SP, Jain NK, Madan A, Deopura G. Intercostal tube thoracostomy in pneumothorax: factors influencing re-expansion of lung. Indian J Chest Dis Allied Sci. 1988; 30:32–35.

18. Baumann MH. Pneumothorax. Semin Respir Crit Care Med. 2001; 22:647–656.

19. Chee CB, Abisheganaden J, Yeo JK, Lee P, Huan PY, Poh SC, et al. Persistent air-leak in spontaneous pneumothorax: clinical course and outcome. Respir Med. 1998; 92:757–761.

20. Mathur R, Cullen J, Kinnear WJ, Johnston ID. Time course of resolution of persistent air leak in spontaneous pneumothorax. Respir Med. 1995; 89:129–132.

21. Jain SK, Al-Kattan KM, Hamdy MG. Spontaneous pneumothorax: determinants of surgical intervention. J Cardiovasc Surg (Torino). 1998; 39:107–111.

22. Waller DA, McConnell SA, Rajesh PB. Delayed referral reduces the success of video-assisted thoracoscopic surgery for spontaneous pneumothorax. Respir Med. 1998; 92:246–249.

23. Maskell NA, Lee YC, Gleeson FV, Hedley EL, Pengelly G, Davies RJ. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size. Am J Respir Crit Care Med. 2004; 170:377–382.