What Is Pneumothorax?
Pneumothorax, a collapsed lung, occurs when air escapes the lung and leaks into the space between the lung and the chest wall. The air puts pressure on the lung, which prevents it from expanding normally when you inhale. Chest injuries, lung diseases, and activities that involve air pressure changes (e.g., scuba diving) can cause pneumothorax. The most common symptoms are sharp, sudden chest pain and shortness of breath.
Healthcare providers use imaging and blood tests to diagnose pneumothorax, which affects about 5 million people in the U.S. annually. Treatment may involve supplemental oxygen therapy or using a needle or chest tube to remove the air from the chest cavity and allow the lung to re-expand, depending on the severity of the lung collapse.
Types of Pneumothorax
There are different types of pneumothorax, which are classified based on what causes the lung to collapse:
Primary spontaneous pneumothorax: Occurs without any known cause in people who do not have an underlying lung disease.
Secondary spontaneous pneumothorax: Occurs in people with a lung disease, such as chronic obstructive pulmonary disease (COPD), tuberculosis, or cystic fibrosis.
Trauma-related pneumothorax: Occurs due to a traumatic injury to the chest, such as a rib fracture, car accident, or a fall.
Iatrogenic pneumothorax: A complication of a medical procedure, such as a lung biopsy or mechanical ventilation. Symptoms and treatment are similar to injury-related pneumothorax.
Catamenial pneumothorax: A rare type of pneumothorax that occurs in menstruating people with endometriosis. When endometrial tissue grows outside the uterus and into the chest cavity, blood can build up in the chest cavity, causing it to collapse.
Symptoms
Symptoms of pneumothorax can range in severity from mild to life-threatening. Common symptoms include:
Sharp, sudden chest pain which may be felt on only one side of the chest and feel worse when taking a deep breath or coughing
Shortness of breath—it may feel like you can’t catch your breath or you’re not getting enough air
Rapid breathing and heart rate
Bluish skin or lips due to a lack of oxygen
Dry cough
If you have symptoms of pneumothorax, seek immediate medical attention. In some cases, pneumothorax can be life-threatening, and early diagnosis and treatment can help prevent complications.
Causes
Pneumothorax occurs when air leaks into the pleural cavity—the space between the lung and the chest wall. Air building up in this space puts pressure on the lung, causing a full or partial collapse.
In some cases, pneumothorax can occur without any known cause, but it is most often caused by lung disease, injury, and lifestyle factors.
Primary Spontaneous Pneumothorax (PSP) Causes
PSP occurs in people with no underlying lung disease and is most common in healthy young adults. Researchers aren’t sure of the exact cause of PSP, but it is most likely due to the formation of small air-filled sacs on the lung surface, known as blebs. When blebs rupture, air can leak into the chest cavity, put pressure on the lung and cause it to collapse.
Secondary Spontaenous Pneumothorax (SSP) Causes
SSP is often caused by an underlying lung disease that weakens lung tissue and increases the risk of pneumothorax. Lung diseases that can cause pneumothorax include:
Traumatic Pneumothorax Causes
Traumatic pneumothorax occurs when the chest is injured, such as during a car accident, or from a gunshot or rib fracture. If the lung becomes punctured during certain medical procedures, such as lung biopsy or nerve block, it may lead to lung collapse.
Other Causes
Certain lifestyle factors can also cause pneumothorax, including:
Pressure changes, such as during scuba diving or traveling at high altitudes
Recreational drug use, especially inhaled drugs such as cannabis, cocaine, and methamphetamines
Smoking
Menstruation, especially in people with endometriosis
Risk Factors
Certain risk factors increase the risk of developing pneumothorax, including:
Smoking: Smoking tobacco, cannabis, and vaping can significantly increase the risk of lung collapse.
Sex: Men are more likely to be affected, especially those who are tall and thin.
Family history: About 1 in 10 people who experience spontaneous pneumothorax with no known cause have a family history of the condition.
How Is Pneumothorax Diagnosed?
To diagnose pneumothorax, your healthcare provider will ask about your symptoms, perform a physical examination, and evaluate your medical history. During the exam, they will listen to your lungs to hear decreased breathing sounds on one side of your chest. They will also watch your chest as you breathe to determine if one side rises and falls normally and the other doesn’t.
If your healthcare provider suspects your lung has collapsed, they may order diagnostic tests to confirm the diagnosis. The primary diagnostic tests include imaging tests and blood tests.
In terms of imaging tests, a chest X-ray, ultrasound, or computed tomography (CT) scan can help visualize the lung and chest cavity to look for a collapsed lung.
For blood tests, arterial blood gas testing measures the amounts of oxygen and carbon dioxide in the bloodstream. Too low oxygen levels (hypoxemia) or too high carbon dioxide levels (hypercapnia) are indicators of pneumothorax.
Treatment
The goal of treatment for pneumothorax is to remove the air from the space between the lung and chest wall to allow the lung to re-expand and restore normal breathing. The specific treatment approach depends on the severity and underlying cause of lung collapse.
For small, uncomplicated pneumothorax, observation and monitoring may be sufficient. For larger and more severe pneumothorax, treatment may include:
Supplemental oxygen: If your pneumothorax is small, you may be given supplemental oxygen to ensure your body gets enough oxygen until the lung collapse resolves on its own within several weeks.
Needle aspiration: A thin needle attached to a syringe is inserted between the ribs into the pleural space to remove the excess air.
Chest tube insertion: A hollow tube is inserted through the chest wall into the pleural space to remove air and allow the lung to re-expand. The tube is left in place for several hours to days to allow the lung to fully re-inflate and prevent the lung from collapsing again.
Pleurodesis: If pneumothorax was caused by injury or you have repeated episodes of lung collapse, pleurodesis may be performed. This involves inserting a tube and adding chemicals (e.g., talc or doxycycline) to help the lung attach to the chest wall and prevent future collapse.
Surgery: In severe cases, surgery may be necessary to repair the lung and prevent pneumothorax recurrence. This may involve a thoracoscopy, a procedure that involves making a small incision in the chest to allow the surgeon to view the lung and remove damaged tissue. The surgeon may also attach the lung to the chest wall with gauze or chemicals (e.g., talc) to prevent a recurrence.
How to Prevent Pneumothorax
There are no specific ways to primary spontaneous pneumothorax because it usually occurs without an identifiable cause. However, certain measures can reduce the risk of developing secondary spontaneous and injury-related pneumothorax. These include:
Manage underlying lung conditions: If you have a lung condition such as COPD, asthma, or cystic fibrosis, work with your healthcare provider to manage your condition and follow your treatment plan as recommended.
Quit smoking: Smoking is a major risk factor for lung disease and can increase the risk of pneumothorax.
Avoid scuba diving and flying: Activities that involve drastic changes in air pressure, such as scuba diving and airplane travel, can increase the risk of pneumothorax. Avoiding these activities if you have a history of pneumothorax or are healing from a recent lung collapse is especially important.
Comorbid Conditions
Pneumothorax is often associated with certain comorbid conditions or underlying medical conditions. In addition to lung diseases, certain conditions increase the risk of pneumothorax:
Lung diseases such as COPD, asthma, and tuberculosis
Connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome
Familial spontaneous pneumothorax, a rare inherited condition that runs in families and is characterized by recurrent episodes of spontaneous pneumothorax
Hypertension (high blood pressure)
Research shows that people who a history of pneumothorax are at an increased risk of developing lung cancer. Those who have experienced spontaneous pneumothorax more than twice per year have a more than 30-fold higher risk of lung cancer than those with no history of lung collapse.
Living with Pneumothorax
Experiencing a pneumothorax can be a scary experience, especially if it causes symptoms like trouble breathing and sharp chest pain. Fortunately, most people with pneumothorax recover without major treatment and long-term complications.
After an episode of pneumothorax, there is a 21-54% risk of it happening again within 1-2 years. If you have a history of pneumothorax or certain factors that increase your risk, you may need to avoid certain activities, such as scuba diving or high-altitude flying. In some cases, people with recurrent pneumothorax may need surgery to attach the lungs to the chest wall to prevent future episodes.
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