Pneumothorax

Overview

Pneumothorax is a painful condition of the lung, commonly referred to as a collapsed lung. In a healthy body, lungs touch the walls of the chest. When air enters this space between the lung and the chest wall, called the pleural space, lung collapses partially or fully giving rise to pneumothorax.  Air enters this pleural space due to an injury or because of a leak in the lung. This lung collapse can exert pressure on the heart, impair oxygenation,and ventilation. At times pneumothorax can be a life-threatening event.

Symptoms of pneumothorax

In the initial stages of pneumothorax, symptoms may not be very prominent. The intensity of the symptoms also varies depending on what caused the lung collapse.In certain cases, symptoms are hardly noticeable and can be detected only through an x-ray or a scan.

• Shortness of breath
• Chest pain, tightness of the chest
• Sometimes pain occurs in the shoulder and/or back
• Dry cough due to irritation of the diaphragm
• Shooting pain while inhaling
• Rapid breathing
• Getting tired or fatigued easily
• Blue discoloration of skin or lips due to insufficient oxygen levels in the body
• Loss of consciousness or coma

In the case of Tension Pneumothorax, cardiovascular collapse can occur which is life-threatening.

What causes pneumothorax?

Causes of pneumothorax can mainly be primary spontaneous pneumothorax (PSP), secondary spontaneous pneumothorax (SSP) and traumatic pneumothorax.

Primary spontaneous pneumothorax(PSP)

People with no known history of lung disease experience this due to various reasons such as:

• Smoking tobacco or cannabis
• Tall men
• Family history of pneumothorax

Secondary spontaneous pneumothorax (SSP)

This is caused due to various lung diseases and is considered more dangerous than PSP.

• Chronic obstructive lung disease (COPD)
• Cystic fibrosis
• Pneumonia
• Tuberculosis
• Sarcoidosis
• Lung cancer
• Severe asthma

Connective tissue disorders also cause SSP

• Ankylosing spondylitis
• Marfan’s syndrome
• Rheumatoid arthritis
• Ehlers-Danlos syndrome
• Polymyositis and dermatomyositis
• Systematic sclerosis

Traumatic pneumothorax

This occurs when there is a trauma to the lungs. Assaults, accidents, fracture of the ribs, certain medical procedures cause a puncture in the chest wall leading to a collapsed lung. Few instances are:

Ruptured air blisters

Air blisters, which develop on the lungs, can burst to cause the air to leak into the pleural space.

Mechanical ventilation

People who need ventilators during emergencies have a chance of a collapsed lung due to an imbalance of air pressure within the chest.

Types of Pneumothorax

Tension pneumothorax and simple pneumothorax are two types of lung conditions that lead to a collapsed lung.  A rather rare type of pneumothorax that affects only women is called Catamenial pneumothorax.

Tension pneumothorax

This condition occurs due to pressure building up in the pleural space and leading to the collapse of one or both the lungs. It happens when inhaled air is trapped in the pleural space and cannot be let out through exhalation. Trapped air puts pressure on the chest walls leading to a lung collapse.Pressure in the lung cavity slows or stops the blood flow to the heart, affecting the cardiovascular system. With less blood flow into the arteries, blood pressure goes down affecting the vital organs in the body. Emergency medical help is required to save the life of a person.

Simple pneumothorax

 In this case, the lung collapses partially causing difficulty in breathing. It is not severe enough to lead to cardiovascular dysfunction. But, this too requires monitoring by the doctor to avoid complications in the future.

Catamenial pneumothorax

Catamenial pneumothorax is extremely rare and affects only women. The exact cause of catamenial pneumothorax is not known. According to observation, 72 hours before or after the menstrual cycle, cysts from inside a woman’s chest release blood between the lung and chest causing pneumothorax. Symptoms include chest pain that radiates to the shoulders. Most often, the right lung is affected. While treatment is similar to that of other forms of pneumothorax, doctors also recommend hormonal therapy.

Who is prone to Pneumothorax?

 Smokers

People who smoke tobacco and cannabis are at risk of a collapsed lung. Smoking also causes cancer. It also affects the ability to draw oxygen.

Mechanical ventilation

People who require assistance in breathing, using mechanical ventilation are at a higher risk of pneumothorax.

Family history

If there is a history of lung diseases in the family, then there is a chance of pneumothorax occurring.

Air blisters

Tall and underweight people aged between 20 and 40 years are prone to pneumothorax caused by ruptured air blisters.

Lung diseases

Patients with chronic obstructive pulmonary disease (COPD) are most likely to have a collapsed lung.

Pneumothorax patients

Those that have experienced a collapsed lung are at risk of a recurrence.

Fractured ribs

People suffering from fractures of the rib due to an injury or osteoporosis, or malnutrition are very susceptible to a pneumothorax.

Premature babies

Children born prematurely often require oxygen support, as their lungs are not fully developed. In severe cases, they are put on mechanical ventilators making them prone to a collapsed lung.

How do specialists diagnose pneumothorax?

Diagnosing pneumothorax is complex because of the variety of symptoms and types.

• Doctors do a clinical examination and find out the history of the patient, which includes habits, family history of lung diseases. The specialist checks for any abnormal sound while breathing
• Specialists ask for an x-ray examination to check for abnormalities in the lung
• Computerized tomography (CT) scan is done for more detailed images especially in the case of trauma patients
• Ultrasound imaging is also used to identify the size and severity of a pneumothorax
• In the case of tension pneumothorax, the evidence of lung collapse is so clear that it calls for immediate medical attention to avoid further damage or death
• Bronchoscopy might be performed to look for obstructions in the air pathways.

Pediatric pneumothorax

Children without any known lung disease can get primary spontaneous pneumothorax. Among children, secondary spontaneous pneumothorax occurs due to congenital malformations, inhaling a foreign object, measles, and trauma to the chest.

Babies born prematurely have underdeveloped lungs, they are in an intensive care unit with oxygen support. Doctors need to monitor for any air leaks so that treatment can be given immediately.

What is the right time to seek medical help?

If a person experiences any one of the following symptoms of pneumothorax, then it is time to get immediate medical help. Anydelay can lead to serious complications.

• Difficulty in breathing
• Trauma to the chest which can be due to an accident, a motor vehicle crash, fall on the ribs, gunshot, stab wounds which call for emergency medical assistance
• Coughing blood post-injury

Treatment for pneumothorax

The extent of lung collapse determines the course of treatment along with the general medical condition of the patient. Treatment aims at relieving the pressure on the lungs and preventing recurrence of pneumothorax. For a successful recovery, it is crucial to understand the cause and the extent of the damage to the lung.

Observation

In minor cases with no symptoms, the lung expands on its own and does not require any medical intervention. Yet, it is important to visit the doctor regularly to assess the recovery. Breathing exercises are necessary to increase lung capacity.

Needle aspiration

In this procedure, a hollow needle with a flexible tube is inserted into the pleural space to suck out the air. While the needle is removed, the syringe witha catheter is allowed to remain inside for a few hours to ensure the lung expands.

Chest tube insertion

It involves inserting a chest tube to suck out the air. This chest tube is attached to a one-way valve to remove the air continuously until the lung expands.

Surgery

With the help of a tiny fiber-optic camera, the surgeon makes a small incision to seal the leaking area. A larger incision may be needed in cases of bigger and multiple leaks. Maintaining airway pressure during the surgery is important and requires an experienced anesthesiologist.

Pleurodesis

This procedure is for patients with recurring pneumothorax. Pleurodesis aims at making the lung membranes stick to the chest cavity. Specialists inject medicine into the pleural space, which triggers an inflammatory reaction.  This ensures air and fluid do not accumulate. Once the pleura stick to the chest wall, it protects against the furtherformation of a pneumothorax. Patients must not consume any anti-inflammatory agents like ibuprofen or naproxen for at least 3 weeks.

Non-surgical repair

Doctors may prescribe medication to numb the pain, and to prevent infections.

Precautions to take during the healing process

Recovery from any illness depends not only on the treatment but also on the care taken during the process of healing.

• In case of minor collapse of the lung, low-impact exercise along with rest helps the healing process. Make sure to follow your doctor’s advice as well as ensure you keep up the mandated medical checkups to monitor the progress
• Avoid playing sports. Take care not to exert by doing strenuous exercises
• Do not lift any heavy objects as it puts pressure on the breathing. Avoid activities such as vacuuming, lawn mowing as you can inhale dust particles. Wear a breathing mask if you are exposed to pollution
• Keep track of any differences in breathing, chest pain, fever or any other complications. Be sure to inform the doctor accordingly
• Avoid air travel for at least 3 weeks after the treatment
• Do not travel to more than 7,500 feet above sea level. Higher altitudes have lower oxygen levels and can cause shortness of breath, called altitude sickness
• Take pain medication as and when needed and prescribed by the doctor
• Inform the doctor if the medication is not enabling relief

Is surgery an option for Pneumothorax?

Most serious cases of pneumothorax require surgery to correct the situation. In most of the emergencies like accident cases, rib fractures, and stab wounds, surgery is the only option to revive the lungs.

When is emergency medical help needed?

• Recent or increased shortness of breath
• Profuse sweating and a feeling of passing out
• Fingernail, toes, and lips turning blue
• Front of the neck or throat pushed to one side
• Incoherent, exhibiting difficulty in thinking

Prognosis for Pneumothorax

• Normal recovery from a collapsed lung takes up to 2 weeks. In minor cases of pneumothorax, there is complete recovery and people can get back to leading normal lives
• In secondary spontaneous pneumothorax, there is a 50% chance of recurrence. It is important to follow your specialist’s advice to avoid recurrence
• Tension pneumothorax is a very serious condition caused due to an injury. Immediate medical help is necessary for the patient’s survival
• There is a chance of pneumothorax recurring in most people within one to two years of the first occurrence. Work with your doctor closely to manage the condition.
• Avoid smoking, high altitude travel,and scuba diving to reduce the risk of a relapse
• In cases of partial recovery from pneumothorax, lifestyle has to be altered to manage the collapsed lung

References