What Is Pneumothorax?
Pneumothorax is air that becomes trapped between the lung and chest wall (known as the pleural space). If air escapes from the lung into the chest cavity, this causes the lung to partially collapse. In some cases, a pneumothorax is caused by an injury or trauma, but it can also occur spontaneously and is most common among young men and tall lean men. It is estimated that 2 in 10,000 young adults in the UK develop a pneumothorax each year and men are four times more likely to develop a pneumothorax than women. Pneumothorax is rare among people over the age of 40.
What causes pneumothorax?
There are different types of pneumothorax and they have different causes:
Primary spontaneous pneumothorax
A primary spontaneous pneumothorax happens very suddenly without any warning. This type of pneumothorax occurs most commonly in healthy young males and the cause is believed to be a tiny tear or defect on the outer portion of the lung. In most cases, the tear is located towards the top of the lung. It is not known why tears occur in the outer lung but it is believed that pneumothorax develops at a site where bullae are present. Bullae are tiny balloon-like structures of tissue, which are not as strong as lung tissue and are therefore prone to tearing, allowing air to escape into the pleural space.
Secondary spontaneous pneumothorax
A secondary spontaneous pneumothorax develops as a result of another illness that affects the lungs. Conditions such as those listed below may cause a pneumothorax:
- COPD (chronic obstructive pulmonary disease).
- Cystic fibrosis.
- Lung cancer.
Other causes of pneumothorax include trauma and injuries; for example, a road traffic accident or a stab wound to the chest.
What are the symptoms of pneumothorax?
Symptoms of pneumothorax include:
- A stabbing pain on one side of the chest, which usually comes on very quickly.
- Severe pain when breathing in.
- Breathing difficulties and breathlessness.
- Coughing or fever if the pneumothorax is caused by injury or an existing lung condition.
In rare cases, the pneumothorax can become very serious, as the tear in the lung tissue starts to act like a one-way valve. This is known as a tension pneumothorax and it should be treated as a medical emergency. Symptoms of a tension pneumothorax include shortness of breath, which gets worse very rapidly.
How is pneumothorax diagnosed?
If doctors suspect that a patient has suffered a pneumothorax, they will order a chest X-ray to confirm or rule out a diagnosis.
Treatment for pneumothorax
The treatment pathway will depend on the severity of the pneumothorax. If you have had a small pneumothorax, you may not require any treatment but you will still be advised to have a chest X-ray to check that the pneumothorax has cleared and you may also be given painkillers.
If you have had a larger pneumothorax doctors may need to release some of the trapped air. This is usually done by inserting a very fine tube into the pleural space, with a syringe fitted to the end of the tube, which sucks in the trapped air. If the pneumothorax is larger, a bigger tube may be needed to remove more air and sometimes the tube is left in place for a few days to allow the tear in the lung tissue to heal. Local anaesthetic will be given prior to the tube being inserted into the chest wall to prevent pain.
If you have had a pneumothorax, you have a higher risk of developing another pneumothorax in the future. If you suffer recurrent pneumothorax you may be advised to have surgery.
It is not safe to fly if you have had a recent pneumothorax and you should wait until a doctor gives you the green light to fly. You should also ensure that you are not going to somewhere remote, where it may take a long time to get treatment if you do suffer another episode. If you smoke, this will increase your risk of developing pneumothorax, so it is a good idea to give up. Quitting will also benefit all your other organs and systems and will reduce your chances of developing a range of life-threatening illnesses, including cancer and heart disease.