What is a pneumothorax. How is a collapsed lung diagnosed. What are the treatment options for pneumothorax. When should you seek medical attention for a collapsed lung. How long does recovery from pneumothorax take. What activities should be avoided after a collapsed lung. Are there any long-term complications of pneumothorax.

What is Pneumothorax and How Does It Occur?

Pneumothorax, commonly known as a collapsed lung, is a condition where air leaks into the space between the lung and chest wall. This trapped air causes the lung to collapse, potentially leading to breathing difficulties and chest pain.

Pneumothorax can occur due to various reasons:

• Spontaneously, often due to a small tear in the outer part of the lung
• As a result of chest injuries, such as broken ribs or penetrating wounds
• Underlying lung diseases like chronic obstructive pulmonary disease (COPD) or cystic fibrosis
• Medical procedures involving the chest cavity

Recognizing the Symptoms of a Collapsed Lung

Identifying the signs of pneumothorax is crucial for timely treatment. Common symptoms include:

• Sudden, sharp chest pain that worsens with breathing or coughing
• Shortness of breath or difficulty breathing
• Rapid heartbeat
• Bluish skin color due to lack of oxygen
• Fatigue
• Dry, hacking cough

In some cases, especially with small pneumothoraces, symptoms may be mild or even absent. However, any persistent chest pain or breathing difficulties warrant immediate medical attention.

Can pneumothorax symptoms vary in severity?

Yes, the severity of pneumothorax symptoms can vary significantly. The extent of lung collapse and the individual’s overall health play crucial roles in symptom intensity. While some people may experience severe chest pain and breathing difficulties, others might only notice mild discomfort or shortness of breath during physical activity.

Diagnostic Approaches for Pneumothorax

Accurate diagnosis of pneumothorax is essential for appropriate treatment. Healthcare providers typically use the following methods:

1. Physical examination: Listening to breath sounds and checking for decreased chest movement on the affected side
2. Chest X-ray: The primary imaging tool for confirming pneumothorax and assessing its size
3. CT scan: Provides detailed images of the lungs and can detect small pneumothoraces that may not be visible on X-rays
4. Ultrasound: Increasingly used in emergency settings for quick assessment

How accurate are chest X-rays in diagnosing pneumothorax?

Chest X-rays are highly effective in diagnosing pneumothorax, with an accuracy rate of about 90-95% for moderate to large collapses. However, small pneumothoraces or those obscured by underlying lung disease may be missed. In such cases, CT scans offer superior sensitivity, detecting even tiny air pockets that X-rays might overlook.

Treatment Options for Collapsed Lung

The appropriate treatment for pneumothorax depends on its size and the patient’s overall condition. Treatment options include:

• Observation: Small, asymptomatic pneumothoraces may resolve on their own with careful monitoring
• Oxygen therapy: Helps the body absorb the trapped air more quickly
• Needle aspiration: A thin needle is inserted to remove excess air
• Chest tube insertion: A tube is placed between the ribs to continuously drain air and allow the lung to re-expand
• Surgery: In recurrent or complicated cases, surgical intervention may be necessary to prevent future occurrences

What factors determine the choice of treatment for pneumothorax?

Several factors influence the treatment approach for pneumothorax:

• Size of the pneumothorax
• Severity of symptoms
• Whether it’s a first-time occurrence or recurrent
• Underlying lung conditions
• Patient’s overall health and ability to tolerate interventions

Healthcare providers consider these factors to tailor the treatment plan to each individual’s needs, aiming for the most effective and least invasive approach possible.

Recovery Process and Post-Treatment Care

Recovering from pneumothorax requires patience and adherence to medical advice. The recovery process typically involves:

1. Rest and limited physical activity to allow the lung to heal
2. Follow-up chest X-rays to ensure complete lung re-expansion
3. Pain management with appropriate medications
4. Gradual return to normal activities as advised by healthcare providers
5. Smoking cessation to reduce the risk of recurrence

Recovery time varies depending on the severity of the pneumothorax and the treatment method used. Most people can return to normal activities within a few weeks, but full recovery may take several months.

What lifestyle modifications are recommended after recovering from pneumothorax?

After recovering from pneumothorax, several lifestyle modifications are often recommended to reduce the risk of recurrence:

• Quitting smoking and avoiding secondhand smoke
• Limiting exposure to air pollution
• Avoiding activities that involve sudden changes in air pressure, such as scuba diving or skydiving
• Gradually resuming exercise under medical guidance
• Managing underlying lung conditions effectively

These changes can significantly improve long-term outcomes and reduce the likelihood of experiencing another collapsed lung.

Potential Complications and Long-Term Outlook

While most cases of pneumothorax resolve without lasting effects, potential complications can include:

• Recurrence, especially in those with underlying lung conditions
• Tension pneumothorax, a life-threatening emergency where air continues to accumulate, compressing the heart and blood vessels
• Prolonged air leak, requiring extended treatment
• Infection in the pleural space (empyema)

The long-term outlook for pneumothorax patients is generally positive, particularly for those experiencing a first-time, spontaneous event. However, the risk of recurrence remains, necessitating ongoing awareness and preventive measures.

How does the risk of pneumothorax recurrence change over time?

The risk of pneumothorax recurrence is highest in the first year following the initial event, with approximately 30% of patients experiencing a second occurrence. This risk gradually decreases over time but remains higher than in the general population. Factors influencing recurrence risk include:

• Smoking status
• Presence of underlying lung diseases
• Age and gender (younger males are at higher risk)
• Previous episodes of pneumothorax

Understanding these risk factors can help patients and healthcare providers develop appropriate long-term management strategies.

Preventive Measures and Risk Reduction

While not all cases of pneumothorax can be prevented, certain measures can help reduce the risk:

• Smoking cessation: The single most effective preventive measure
• Protective equipment: Using appropriate gear during contact sports or high-risk occupations
• Managing underlying lung conditions effectively
• Avoiding sudden pressure changes: Being cautious with activities like scuba diving or flying
• Regular check-ups: Especially for those with a history of pneumothorax or lung disease

Can genetic factors influence the risk of developing pneumothorax?

Yes, genetic factors can play a role in pneumothorax risk. Certain genetic conditions, such as Marfan syndrome, Ehlers-Danlos syndrome, and Birt-Hogg-Dubé syndrome, are associated with an increased likelihood of developing spontaneous pneumothorax. These conditions often affect connective tissue or lung structure, making individuals more susceptible to air leaks. While genetic predisposition doesn’t guarantee the occurrence of pneumothorax, it underscores the importance of genetic counseling and regular medical monitoring for those with relevant family histories or known genetic conditions.

Special Considerations for Air Travel and Diving

Air travel and diving pose unique risks for individuals with a history of pneumothorax due to changes in atmospheric pressure. Guidelines for these activities include:

• Avoiding air travel during active pneumothorax
• Waiting at least 1-2 weeks after full resolution before flying, confirmed by chest X-ray
• Consulting a physician before resuming scuba diving, which may be permanently contraindicated for some individuals
• Considering alternative modes of transportation during the high-risk period (up to one year after pneumothorax)

These precautions are crucial in preventing the potentially life-threatening complication of tension pneumothorax.

How do altitude changes affect individuals with a history of pneumothorax?

Altitude changes can significantly impact individuals with a history of pneumothorax due to variations in atmospheric pressure. As altitude increases, the air pressure decreases, which can cause any residual air trapped in the pleural space to expand. This expansion may lead to:

• Recurrence of pneumothorax
• Exacerbation of symptoms in partially healed cases
• Increased risk of tension pneumothorax during rapid ascents

For this reason, individuals with a recent history of pneumothorax are advised to avoid high-altitude activities and to ascend gradually when necessary. Consultation with a pulmonologist before engaging in high-altitude travel or activities is highly recommended to assess individual risk and receive personalized guidance.

Emerging Treatments and Research Directions

The field of pneumothorax management is continuously evolving, with several promising developments:

• Minimally invasive surgical techniques for recurrent pneumothorax
• Advanced imaging methods for early detection and monitoring
• Novel sealant materials to prevent air leaks
• Gene therapy research for genetic predispositions to pneumothorax
• Improved portable drainage systems for outpatient management

These advancements aim to improve treatment efficacy, reduce recovery time, and enhance the quality of life for pneumothorax patients.

What role does personalized medicine play in pneumothorax treatment?

Personalized medicine is increasingly important in pneumothorax treatment, tailoring approaches based on individual patient characteristics:

• Genetic profiling to identify risk factors and guide prevention strategies
• Customized treatment plans considering patient age, lifestyle, and overall health
• Targeted therapies for specific underlying lung conditions contributing to pneumothorax
• Precision in surgical interventions using advanced imaging and robotic assistance
• Individualized follow-up protocols based on recurrence risk assessment

This personalized approach aims to optimize outcomes, minimize complications, and improve long-term management of pneumothorax, reflecting the broader trend towards more individualized healthcare across medical specialties.

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

North Tees and Hartlepool NHS Foundation Trust

Information:

Information for patients
This leaflet can be made available in other formats including large print, CD and Braille and in languages other than English, upon request.

What is a pneumothorax?

A pneumothorax is also known as a collapsed lung. It is a condition when air has leaked out from the lung in to the chest cavity and chest wall. This causes the lung to collapse down and peel away from the inside of the chest.

What causes a pneumothorax?

There are different types of pneumothorax:

• Primary pneumothorax: This is when someone has developed as pneumothorax who doesn’t have any known lung problems. Usually the air has leaked from a blister or bleb on the surface of the lung which has been present from birth.

• Secondary pneumothorax: This is the term applied when a patient has a known underlying lung condition which predisposes them to this problem. For example, Chronic Obstructive Pulmonary Disease (COPD) or emphysema.

• Traumatic pneumothorax: This refers to when someone has suffered an injury to the chest wall such as a fall which has caused damage to the surface of the lung

• Iatrogenic pneumothorax: Describes when a pneumothorax has happened after a medical procedure. This can include lung biopsies, camera tests and procedures to remove the fluid from the lung.

A pneumothorax can happen more commonly in smokers. There are rarer genetic lung conditions which can predispose people to lung damage who can develop a pneumothorax because of this.

What symptoms might I get?

The most common symptoms are sudden shortness of breath and chest pain (which may be sharp and worse with coughing and breathing).

You may also experience a dry cough.

If air has leaked out into the muscles and skin in your chest wall you may notice a swelling and a “bubble wrap” sensation if you press on your chest.

Occasionally if the leak of air has been very large you may feel faint or light headed.

How is it diagnosed?

The most important investigation to diagnose a pneumothorax is a chest X-ray. This is usually enough in most cases to show the collapsed lung.

Sometimes a CT scan, which is a three dimensional X-ray, may be arranged for a more detailed assessment of the pneumothorax, or if the team aren’t confident based on your chest X-ray.

You may also have other tests in addition to X-rays. These can include blood tests and heart tracings (ECGs), especially if you have been very unwell. This is to look for other causes and have an idea of how the pneumothorax is affecting the rest of your body.

If the pneumothorax has made you very unwell when you were first admitted, the doctors may have had to do a procedure to relieve it before you had an X-ray or any other tests. This is very rare.

What treatment might I have?

The treatment for your pneumothorax would depend on how large it was and also how unwell it made you.

A small pneumothorax may not need any treatment. In this case the lung heals itself and gradually reabsorbs the air that has leaked out.

This generally takes 1 – 2 weeks. In this situation you may be admitted to hospital overnight and have another chest X-ray the following morning to make sure that no more air has leaked out.

You will normally be brought back for further X-rays as an outpatient until your lung has returned to normal.

Larger pneumothoraxes may need a procedure to remove the air and allow the lung to re-inflate. These can include:

Pleural Vent

This a small chest drain which is inserted in the upper part of the front of your chest wall. It allows the air to escape from your chest. It is used in patients whose pneumothorax is expected to take 1 – 3 days to heal.

It is inserted under local anaesthetic and you can return home shortly after it has been put in. You will need to return to clinic usually every day or two to check that things are getting back to normal

Pleural aspiration

This is a procedure where a small needle or plastic tube is inserted between the ribs of your upper chest wall and the air removed using a syringe.

This is a fairly simple procedure, done under local anaesthetic. It is normally performed when a patient has had a pneumothorax in a situation that the lung is expected to heal very quickly. This may happen after a procedure such as a lung biopsy.

Chest drain (Intercostal drain)

This is a procedure where a small plastic tube (slightly larger than the one used for a pleural aspiration) is inserted between the ribs. This is usually inserted in your armpit or back. This tube usually stays in place for at least 24-48 hours.

It is attached to a small plastic fluid filled container which sits on the floor next to your bed. This allows the air to bubble out without going back into your chest. The chest drain is removed when the air has stopped bubbling out of the drain and the team are happy that the lung has healed.

Very occasionally the tear in the lung doesn’t heal. In this situation we may apply ‘suction’ to the drain to draw air out. If this still doesn’t heal the lung, we may ask the chest surgeons to consider doing an operation to try and find the damage to the lung and repair it.

Could this happen again?

About 1 in 3 people who have had a pneumothorax will have another within 12 months.

This is more likely if you continue to smoke if or if you have an underlying condition.

What can I do to help myself get better?

If you smoke the best thing you can do is to stop or cut down.

While you are getting better we do encourage gentle exercise such as walking. You will feel more easily breathless than usual for you.

We ask you to avoid strenuous exercise and lifting heavy objects for at least 4 weeks.

What is it happens again?

If your symptoms come back, we ask you to attend your nearest A&E department. If you are unwell please ring 999 and explain that you have had a pneumothorax recently and that you are feeling the same symptoms. If you are well enough to make your own way to hospital, we ask you not to drive but to get someone else to.

If your pneumothorax has come back, the treatment is likely to be the same initially. Once you have recovered we will refer you to a chest surgeon. They will consider an operation to look inside your chest and perform a procedure to stop this happening again.

We only refer you for this if you have had at least two collapsed lungs on the same side of your chest or if both of your lungs have collapsed at different times.

Will I need any other tests or follow up?

You will usually be asked to come back to the chest clinic, especially if you have had a small pneumothorax which hasn’t had any treatment.

If your team suspect there may be an underlying condition that has caused this pneumothorax, they may also ask you to have blood tests, CT scans and breathing tests. They will arrange for you to come to clinic to review the results.

What other things do I need to think about?

You should not fly while your lung is healing. Most airplane companies will allow you to fly 2 weeks after a chest X-ray which has shown that the pneumothorax has healed.

We are more conservative and would advise you to wait at least 6 weeks and preferably 3 months before you consider flying.

If you have had a pneumothorax we advise you never to take up scuba diving as a hobby, unless you have had surgery to repair the damaged bit of lung.

You are unlikely to be offered employment as a professional diver if you have had a pneumothorax unless you have had a definitive operation to your chest to ensure that it cannot happen again.

The British Lung Foundation

https://www.blf.org.uk/support-for-you/pneumothorax

Lung Health
Telephone: 01642 624270

Department of Respiratory Medicine
Monday – Friday
9 am – 5 pm
Telephone: 01642 624936

Emergency Department
24 hours a day, 7 days a week
Telephone: 01642 382899

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Privacy Notices

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]

Leaflet Reference: PIL1217
Date for Review: 28/08/2023

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