1. Spontaneous Pneumothorax
By definition spontaneous pneumothoraces occur in the absence of any trauma (including iatrogenic causes) to the chest wall.
- Primary spontaneous pneumothoraces occur in people with no underlying lung pathology.
- Secondary spontaneous pneumothoraces occur in patients with pre-existing lung parenchymal or pleural pathology (e.g. asthma, lung carcinoma).
All patients with secondary pneumothoraces should be admitted and, unless specifically contraindicated, be given high concentration oxygen. Administration of oxygen at 15 l/min via a non-rebreathe mask will increase the rate of resolution of the pneumothorax by 4 times compared to breathing room air.
Advice to patient if discharged from the ED with small primary pneumothorax
- Stop smoking (if smoker) and to seek help from his GP to do this. The risk of recurrence will be much higher should he continue to smoke.
- To return to the ED for a repeat chest radiograph and senior doctor review after 2 weeks, or sooner if he becomes more breathless. Although it would be preferable for him to see a respiratory specialist, it may be impossible to access specialist clinics in the recommended timeframe. But, in some Trusts they have arrangement to see chest specialists early.
- Avoid flying for at least a week after a chest radiograph has confirmed complete resolution of his pneumothorax (BTS Air Travel Working Party)
- To avoid underwater diving permanently unless he has bilateral open surgical pleurectomy (The British Thoracic Society Fitness to Dive Group)
BTS. Emergency oxygen use in adult patients, 2008.
BTS. Emergency oxygen use in adult patients, 2008.
CAP 6: Breathlessness
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