What is Pneumothorax in the Lungs?

Pneumothorax: A Complication of COPD

X-ray chest front view, 36 year old male
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Pneumothorax—commonly known as a “collapsed lung”—is defined as the accumulation of air or gas in the space between the lung and the chest wall. Also known as a collapsed lung, pneumothorax occurs when a hole develops in the lung that allows air to escape into the space around the lung, causing the lung to partially or completely collapse. In the United States, 5 million people are treated for it each year.

Pneumothorax can occur for many reasons, some of which are still poorly understood. In the past, it occurred most frequently in conjunction with tuberculosis. Today, smoking is by far the greatest risk factor. People who have chronic obstructive pulmonary disease, or COPD, are at greater risk for pneumothorax because the structure of their lungs is weak and vulnerable to the spontaneous development of these types of holes.

Symptoms

Symptoms of pneumothorax may develop during rest, sleep, or while awake, or because of a sudden trauma such as a chest wound. A small pneumothorax may even go unnoticed, since it is not always accompanied by symptoms. Symptoms of a large pneumothorax include:

  • sharp chest pain that gets worse when coughing or taking a deep breath and may radiate to the shoulder, arm, or back
  • shortness of breath (called dyspnea) or shallow breathing
  • chest tightness
  • being easily fatigued
  • blue or ashen skin (called cyanosis, this is caused by lack of oxygen)
  • rapid heart rate (called tachycardia)

Other symptoms may include distended neck veins, nasal flaring, anxiety, or low blood pressure (hypotension).

Since symptoms can range from mild to severe, it’s not uncommon for it to take several days to realize something is wrong and seek treatment. If you develop any symptoms of pneumothorax, especially if you have had this or another lung condition in the past, however, be sure to seek immediate medical attention. In some cases, it can be a life-threatening emergency.

Since symptoms of pneumothorax can range from mild to severe, it’s not uncommon for it to take several days to realize something is wrong and seek treatment. If you develop any symptoms of pneumothorax, be sure to seek immediate medical attention. In some cases, it can be a life-threatening emergency.

Causes

Pneumothorax can be caused by a number of diseases and conditions. There are two general types: the first, primary pneumothorax, occurs spontaneously, without prior lung disease. Secondary pneumothorax occurs as a result of an underlying lung disease, such as COPD, cystic fibrosis, emphysema, asthma, tuberculosis, and whooping cough can result in pneumothorax.

Pneumothorax can also be caused by an injury to the lung, such as a gunshot, knife wound, or rib fracture. The lung can also be punctured during certain medical procedures, such as a biopsy or venous catheterization. Air pollution and sudden air pressure changes from scuba diving or traveling to a high altitude can also contribute to a collapsed lung.

Rarely, for reasons not well understood, women may experience a non-traumatic pneumothorax during their menstrual period. Even loud music—what you’d experience standing in front of a speaker at a rock concert—may have enough effect on the lungs to be a cause.

Very loud music—what you’d experience standing in front of a speaker at a rock concert—is a possible cause of a collapsed lung.

Sometimes the cause of the pneumothorax may be impossible to determine. There is no way to prevent a pneumothorax, but you can reduce your risk by not smoking.

Men—especially tall men—under the age of 40 and whites of non-Hispanic origin are most at risk for this disorder. In the United States, incidence is about 7 in 100,000 for men, and 1 in 100,000 women each year.

Smoking is the most significant risk factor for secondary pneumothorax. For smokers, the lifetime risk is as high as 12 percent, compared to 0.1 percent in those who have never smoked. Combining cigarette and cannabis smoking may also significantly increase risk over smoking cigarettes alone.

Pneumothorax can also run in families. As many as one in 10 people who experience a pneumothorax that occurs for no known reason have a family history of the disorder.

Diagnosis

Your doctor may determine you have pneumothorax during a physical examination by listening through a stethoscope and identifying decreased or absent breath sounds on the affected side of the lung.

In addition, the chest wall, which normally rises equally on both sides upon inhalation, may show an inability to rise on the affected side.

Tests that support a diagnosis of pneumothorax include chest x-ray, ultrasonography, computerized tomography (CT) scan, electrocardiogram, and measuring blood oxygen and carbon dioxide levels (called arterial blood gas testing).

Treatment

In some cases, smaller pneumothoraces go away on their own. However, a large pneumothorax will require hospitalization.

To treat a pneumothorax, a needle must be inserted between the ribs into the space between the lung and the chest wall in a procedure called called needle aspiration to help remove the air and reinflate the lung. A chest tube (called a thoracostomy tube) may then be inserted once air has been removed. The chest tube stays in place for several days while you recover in the hospital. If the pneumothorax recurs, video-assisted thoracic surgery may be required.

Inserting the tube or needle can be painful, so you may receive painkillers by IV or regional anesthesia. You may also be given antibiotics to prevent infections. If you’re treated in an emergency room, you might receive a referral to a thoracic surgeon or pulmonologist for further care.

Coping

If you have a pneumothorax, you should not fly until you’ve received stabilizing treatment (such as with a thoracostomy tube). You also should not fly or scuba dive for two weeks following discharge from a hospital after being treated. If you have a history of recurrent pneumothorax, always use caution when flying or scuba diving.

The risk of having another pneumothorax is highest in the first 30 days after your first occurrence. Over the next year, the risk of having another also remains higher than normal. Estimates of recurrence vary from 20 percent to up to 60 percent during the first three years. The good news is that once a pneumothorax has healed, there are usually no long-term complications.

A Word From Verywell

Because it affects one of the body’s most basic functions—breathing—experiencing a pneumothorax may be frightening. It’s important to remember that while it’s a serious condition, it is highly treatable. Prompt medical care and continuing to take care of your lungs and health over time will help ensure a full recovery. 

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