What are the symptoms of a collapsed lung. How is pneumothorax treated. What precautions should patients take after experiencing a pneumothorax. When should you seek urgent medical attention for pneumothorax complications.

Understanding Pneumothorax: A Comprehensive Overview

Pneumothorax, commonly known as a collapsed lung, is a condition where air becomes trapped between the lung and the chest wall. This medical issue can arise from various causes, including injuries or spontaneously without any apparent reason. To better understand this condition, let’s delve into its nature, causes, and implications for patients.

What Exactly is a Pneumothorax?

A pneumothorax occurs when air accumulates in the pleural space – the area between the lung and the chest wall. Normally, this space contains a small amount of lubricating fluid to facilitate smooth lung movement during breathing. However, when lung damage occurs, air can leak into this space, causing the lung to collapse partially or fully.

Who is at Risk?

While pneumothorax can affect anyone, certain groups are more susceptible:

• Men are more likely to experience spontaneous pneumothorax than women
• Smokers have an increased risk
• Individuals with underlying lung diseases are more prone to this condition
• People who have experienced trauma to the chest area

Recognizing the Symptoms of Pneumothorax

Identifying the symptoms of pneumothorax is crucial for timely medical intervention. The primary indicators include:

• Chest pain, which can be sharp and sudden
• Shortness of breath or difficulty breathing
• A dry cough that may persist

Is the onset of symptoms always sudden? Not necessarily. In some cases, particularly with smaller pneumothoraces, symptoms may develop gradually. It’s important to note that the severity of symptoms often correlates with the size of the pneumothorax.

Treatment Approaches for Pneumothorax

The treatment for pneumothorax varies based on several factors. Healthcare providers consider the following when determining the most appropriate course of action:

1. The cause of the pneumothorax (spontaneous or traumatic)
2. Presence of underlying lung disease
3. Severity of symptoms
4. Size of the pneumothorax

Treatment Options

Depending on the assessment, treatment may involve:

• Observation: For very small pneumothoraces without significant symptoms, healthcare providers may opt for a wait-and-see approach, allowing the body to reabsorb the air naturally.
• Needle aspiration: In cases where intervention is necessary but the pneumothorax is relatively small, doctors may use a needle to remove the excess air.
• Chest tube insertion: For larger pneumothoraces or those causing significant breathing difficulties, a chest tube may be inserted to drain the air continuously.

Do all patients with pneumothorax require hospitalization? Not necessarily. While those requiring chest tube insertion typically need to stay in the hospital, patients who undergo needle aspiration may be able to return home, provided they follow up with their healthcare provider as instructed.

Managing Pain Associated with Pneumothorax

Pain management is an essential aspect of pneumothorax treatment. Patients often experience discomfort, and addressing this can significantly improve their recovery experience.

Recommended Pain Relief Options

• Paracetamol: This over-the-counter medication is often the first line of defense against pain. The recommended adult dose is two 500 mg tablets, taken four times a day.
• Codeine: For more severe pain, doctors may prescribe codeine, often in combination with paracetamol.
• Non-steroidal anti-inflammatory drugs (NSAIDs): Medications like ibuprofen can be effective in reducing pain and inflammation.

Can patients take multiple pain medications simultaneously? While combining different types of pain relievers can be effective, it’s crucial to follow medical advice. For instance, if prescribed a combination of paracetamol and codeine, patients should avoid taking additional paracetamol to prevent accidental overdose.

Recovery and Follow-up Care After Pneumothorax

Recovering from a pneumothorax requires careful attention to follow-up care and certain lifestyle modifications. Patients should be aware of the following guidelines:

Follow-up Appointments

Regardless of the initial treatment approach, patients are typically scheduled for a follow-up appointment 7-10 days after their diagnosis. This visit usually includes a chest X-ray to ensure the pneumothorax has resolved completely.

Air Travel Restrictions

Flying with an active pneumothorax is strictly prohibited due to the risk of air expansion at high altitudes, which could lead to a life-threatening tension pneumothorax. Even after resolution, patients should adhere to the following guidelines:

• Wait at least one week after a clear chest X-ray before flying
• For traumatic pneumothorax, the waiting period extends to two weeks
• Consider alternative transportation methods for up to a year post-pneumothorax, as the risk of recurrence remains elevated during this period

Scuba Diving Precautions

Scuba diving poses significant risks for individuals with a history of pneumothorax:

• Those who have experienced a spontaneous pneumothorax should avoid scuba diving indefinitely
• Individuals whose careers depend on diving may need to consult with medical professionals about surgical options to prevent recurrence
• Patients with a history of traumatic pneumothorax may be cleared for diving after thorough medical evaluation

Are there any permanent lifestyle changes required after experiencing a pneumothorax? While most patients can return to their normal activities after full recovery, those with recurring pneumothoraces or underlying lung conditions may need to make long-term adjustments, particularly regarding high-risk activities like scuba diving.

Recognizing Complications and When to Seek Help

While most cases of pneumothorax resolve without significant complications, patients should remain vigilant for signs that may indicate a worsening condition or recurrence.

Red Flags: When to Seek Immediate Medical Attention

Patients should contact their healthcare provider or seek emergency care if they experience:

• Increased shortness of breath or difficulty breathing
• Worsening chest pain
• Sudden onset of dizziness or lightheadedness
• Bluish discoloration of the lips or fingertips (cyanosis)
• Rapid heart rate or palpitations

How quickly should patients respond to these warning signs? Immediate action is crucial. These symptoms could indicate a tension pneumothorax, a medical emergency that requires prompt intervention.

Preventing Recurrence: Lifestyle Modifications and Medical Interventions

While not all cases of pneumothorax are preventable, certain measures can reduce the risk of recurrence, especially for those who have experienced a spontaneous pneumothorax.

Lifestyle Changes

• Smoking cessation: Quitting smoking is one of the most effective ways to reduce the risk of recurrent pneumothorax
• Avoiding extreme altitude changes: This includes both high-altitude activities and deep-sea diving
• Regular exercise: Maintaining good overall lung health through regular, moderate exercise can be beneficial

Medical Interventions

For patients with recurring pneumothoraces or those at high risk of recurrence, doctors may recommend:

• Pleurodesis: A procedure that creates scar tissue between the lung and chest wall to prevent air from accumulating
• Bullectomy: Surgical removal of blebs (small air-filled sacs on the lung surface) that may be causing recurrent pneumothoraces
• Video-assisted thoracoscopic surgery (VATS): A minimally invasive surgical technique used to treat recurrent pneumothorax

Can these interventions guarantee prevention of future pneumothoraces? While these treatments significantly reduce the risk of recurrence, they cannot provide an absolute guarantee. Patients should maintain regular follow-ups with their healthcare providers and remain aware of potential symptoms.

Living with the Risk: Long-term Outlook for Pneumothorax Patients

Understanding the long-term implications of having experienced a pneumothorax is crucial for patients to manage their health effectively and maintain a good quality of life.

Long-term Health Considerations

• Increased vigilance: Patients should remain alert to symptoms that might indicate a recurrence
• Regular check-ups: Scheduled follow-ups with pulmonologists or thoracic specialists may be recommended
• Lung function monitoring: Periodic lung function tests can help track overall respiratory health

Emotional and Psychological Impact

Experiencing a pneumothorax can have psychological effects on patients, including:

• Anxiety about recurrence
• Concerns about engaging in physical activities
• Stress related to lifestyle modifications

How can patients address these psychological aspects? Healthcare providers may recommend counseling or support groups to help patients cope with the emotional impact of their condition. Additionally, staying informed about their condition and maintaining open communication with their medical team can help alleviate anxiety.

Career and Lifestyle Adjustments

Some patients may need to consider long-term adjustments to their careers or lifestyles, particularly if they work in fields that involve:

• High-altitude environments (e.g., aviation)
• Diving or underwater work
• Heavy lifting or strenuous physical activity

In such cases, career counseling or vocational rehabilitation may be beneficial to explore alternative options that align with the patient’s health needs.

Is it possible to lead a normal life after experiencing a pneumothorax? For most patients, yes. While some precautions may be necessary, especially in the first year following the incident, many individuals return to their regular activities and enjoy a full, active life. The key lies in understanding one’s condition, following medical advice, and making informed decisions about activities and lifestyle choices.

Pneumothorax (Collapsed Lung) | Display Patient Information Leaflets

Date issued: December 2022 

Review date: December 2024

Ref: A-564/NB/ED/Pneumothorax (Collapsed Lung)

PDF:  Pneumothorax Collapsed Lung final December 2022.pdf [pdf] 139KB

What is a pneumothorax (new-mo-thor-ax)?

This means the lung has collapsed and there is air between the lung and the chest wall.  Normally this space is very small and only contains some lubricating fluid, but lung damage means air leaks into the space as well.

They can occur following injury or spontaneously.  Spontaneous pneumothoraces are more common in men, smokers and those with underlying lung disease.

Symptoms include chest pain, shortness of breath and a dry cough.

What is the treatment?

This depends on several factors:

• The cause of the pneumothorax (spontaneous or traumatic)

• Whether or not you have underlying lung disease

• What symptoms you have

• How big the pneumothorax is.

Generally speaking, if your pneumothorax was caused by trauma or is very large or making you short of breath then we will need to remove it either by sucking the air out through a needle or by placing a tube called a chest drain.  In the latter case you will need to stay in hospital but you may be able to go home if only a needle is required (aspiration of the pneumothorax).

If it is very small and isn’t causing breathing difficulties, then it is very likely to resolve without treatment.

Whether or not it is drained, it is important that you return to clinic in 7-10 days (you will be given an appointment before leaving the Emergency Department).

Can I take painkillers?

• Paracetamol is useful to ease pain. It is best to take it regularly for a few days or so, rather than every now and then. An adult dose is two 500 mg tablets, four times a day. A doctor may pre-scribe additional painkillers such as codeine if the pain is more severe.   If you are prescribed a combination of paracetamol and codeine (e.g., cocodamol or codydramol) then it is important not to take additional paracetamol as you will accidentally overdose

• Anti-inflammatory medication can be used with paracetamol or as an alternative. There are many types and brands. They relieve pain and reduce inflammation and swelling (often the cause of the pain). You can buy ibuprofen at pharmacies or supermarkets without a prescription. The dose varies depending on your age and other medical problems. Side-effects sometimes occur with anti-inflammatory painkillers. Ask your doctor or pharmacist for advice regarding them

If pain is not controlled by these simple painkillers, do not exceed the recommended dose but see your general practitioner to discuss the possibility of stronger painkillers.

South Tees Hospitals NHS Foundation Trust

Emergency Department and Minor Injury Unit

You have been given this information because you have been diagnosed with a pneumothorax.

A pneumothorax (collapsed lung) occurs when air is trapped between a lung and the chest wall. This can occur from an injury, such as broken ribs or a wound to the chest, but commonly occurs spontaneously. Spontaneous pneumothorax is thought to be due to a tiny tear of an outer part of the lung.

Treatment of a pneumothorax

A small pneumothorax may require no treatment.

A larger pneumothorax, that is causing shortness of breath, may be treated with a tube inserted into the chest known as a chest drain.

Recovering from a pneumothorax

Flying

If you currently have a pneumothorax you should not fly at all. This is because of the risk of the trapped air expanding and causing a tension pneumothorax (a life-threatening emergency), which can happen when the air pressure around you changes.

If you have had a recent pneumothorax you should have a chest x-ray performed prior to flying to ensure that it has resolved.

It is recommended that you wait at least 1 week after this chest x-ray before flying, or 2 weeks if your pneumothorax was caused by an injury.

The risk of recurrence does not fall significantly for at least 1 year, and is higher in those with coexisting lung disease. You may wish to consider alternative forms of transport during this time.

Scuba diving

This also increases the risk of developing a tension pneumothorax.

You should not scuba dive if you have ever had a spontaneous pneumothorax. If your occupation relies on diving, you may be suitable for an operation to prevent recurrence and allow you to dive again.

You may be able to dive if you have had a traumatic pneumothorax, but this depends on further investigation. Please discuss this with your GP.

Follow-up after a pneumothorax

You will be given a clinic appointment to ensure your pneumothorax has resolved. This will involve a chest x-ray.

You should seek urgent medical attention if any of the following occur:

• Increased shortness of breath
• Severe sharp, stabbing chest pain (pleuritic pain)

Treating pain

If needed, painkiller options include the following:

• Paracetamol is usually recommended for painful sprains or strains.

• Non-steroidal anti-inflammatory drugs (NSAIDs) relieve pain and may also limit inflammation and swelling. You can buy some types (for example, ibuprofen) at pharmacies, without a prescription either topically as a cream, or as tablets. You should check the medication advice leaflet to ensure you are safe to take these as some patients with asthma or stomach ulcers may not be able to.

If this does not help, you may need an additional stronger painkiller – such as codeine – you should discuss this with your pharmacist or GP.

For further advice and information about your condition, please choose from the following:

• ‘NHS Patient Choices’ website: www.nhs.uk
• ‘Making Lives Better’ patient website: www.patient.info
• Telephone NHS 111
• Contact your General Practitioner

Contact details

• The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW
  Telephone: 01642 850850
• The Friarage, Northallerton, North Yorkshire, DL6 1JG
  Telephone: 01609 779911
• Redcar Primary Care Hospital, West Dyke Road, Redcar, TS10 4NW
  Telephone: 01642 511000

Patient experience

South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.

This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.

To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.

T: 01642 835964
E: [email protected]

The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW.

Telephone: 01642 850850

ST1614

Page published:
10/12/2021

Page last updated:
03/03/2023

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