How many people have spontaneous pneumothorax

Age cohorts from 10—15 to 90 years and older. Based on the cause-of-death statistics, disease-specific mortality for spontaneous pneumothorax is 0.

Overall, lethality increased When evaluating the patients who died in hospital in-hospital mortality , it should be borne in mind that patients with pneumothorax as the primary diagnosis not necessarily died of this condition. Similar to the distribution in lethality, the number of deaths with pneumothorax as the primary diagnosis showed an increase beyond age 45 Figure 2 and eTable 1.

In the age group 15—20 years, 0. Percentage share of pneumothorax deaths in the total number of inpatient cases with pneumothorax as the primary diagnosis — in-hospital mortality , age-differentiated age cohorts from 10—15 to 90 years and older.

Among the pulmonary secondary diagnoses relevant to secondary spontaneous pneumothorax eTable 2 , COPD J44 tops the list with cases In the age distribution of the aggregated pulmonary secondary diagnoses, a peak around age 70—80 is observed; in spontaneous-pneumothorax patients younger than age 45, the mentioned secondary diagnoses occur only rarely Figure 3. Number of primary diagnoses of pneumothorax J93 and number of aggregated pulmonary secondary diagnoses of COPD J44 , interstitial pulmonary disease J84 , pneumonia J18 , lung cancer C34 , —, age-differentiated age cohorts from age 10—15 to 90 years and older.

In 52 cases of spontaneous pneumothorax, altogether 24 chest CT scans The age distribution Table 2 showed that CT scans were indicated in During the period studied, altogether 40 tube thoracostomies were performed in patients with pneumothorax as the primary diagnosis eTable 3.

Either a small-bore chest tube OPS 8— Of the 52 cases with spontaneous pneumothorax included, up to three quarters underwent tube thoracostomy multiple coding per inpatient stay possible. Thoracentesis, which can only be entered once per inpatient hospital stay, was coded in cases 2.

During the period from to , altogether 30 surgical procedures, including atypical pulmonary resection, pleurectomy and pleurodesis, were coded in various combinations together with the primary diagnosis of spontaneous pneumothorax. This total does not reflect the number of operated patients. The share of chest surgeries in hospitalized cases is at least Table 1 and eTable 4 provide a breakdown of the surgical procedures performed:.

Atypical pulmonary resection was performed in cases, accounting for In the age group 10—40 years In Pleurectomy was performed in 11 cases With cases In about one third of all pleurodesis cases, a subgroup treated with talc poudrage pleurodesis spraying talc powder into the pleural space to induce aseptic pleuritis was reported; this technique was less commonly used in the younger age group 2. The aim of this study was to provide insights into the epidemiology and management of pneumothorax in Germany based on an analysis of current data from the Federal Statistical Office.

The key strength of this study lies in the availability of a great quantity of pneumothorax-related data. The German Federal Statistical Office records all hospitalized cases of pneumothorax.

Consequently, only cases of pneumothorax diagnosed and treated exclusively in an outpatient setting were not included in this study. This study is limited by restrictions imposed by data protection rules: It cannot be distinguished between new cases and recurrences; information about diagnostic parameters and procedures cannot be attributed to specific patients.

Consequently, detailed statements regarding the following parameters cannot be made:. Not least, data quality is as good as the coding quality in the various hospitals.

This also applies to the documentation quality in the cause-of-death statistics. The sex-specific results on the frequency of hospitalized cases with pneumothorax as the primary diagnosis, including the sex ratio 1 : 3. In men, a bimodal age distribution was found, consistent with the findings of the study of Gupta et al.

The pathophysiology underlying this difference in sex-specific distribution, especially among young patients, is still not understood. That differences in smoking habits between men and women 8 , which are discussed as a potential cause, play a role is not supported by current statistics of the Robert Koch Institute 9.

The diagram of secondary pneumothorax with pulmonary secondary diagnoses Figure 3 indicates that starting from age 45 years, the incidence of pneumothorax is more and more determined by underlying pulmonary conditions.

These findings support the threshold of age 50 years, pragmatically set in the guideline of the British Thoracic Society BTS 10 , beyond that every spontaneous pneumothorax in patients with a significant smoking history is classed as secondary. Lethality and in-hospital mortality are clearly age-dependent.

In the age group 15—40 years, 0. A similar difference is found for lethality: 0. In-hospital mortality has to be greater than lethality because deaths due to other diseases in patients with the primary diagnosis spontaneous pneumothorax J93 are added to the deaths caused by pneumothorax.

Our results suggest that in the younger age group spontaneous pneumothorax does not constitute the same vital threat it clearly represents in the higher age group. This should be considered in and communicated to young patients in particular to alleviate any unnecessary fears.

Chest CT scans are performed in the younger age group in The authors think that chest CT scans are performed too frequently in the younger age group age 10—40 years. The current BTS guideline 10 recommends the use of CT scans in unclear cases, such as cases with minor pneumothorax hardly visible in chest radiographs or in complex cases with additional soft-tissue edema, pulmonary disease or unsuccessful tube thoracostomy.

In a current review, CT scans are recommended for special queries only and not for the standard diagnostic workup In our study, the coded pulmonary secondary diagnoses which may represent indications for a CT scan account for at most 5. Rates of 4. A preoperative CT scan did not improve the outcome of thoracoscopic surgery in patients with primary spontaneous pneumothorax 15 , The extent of the expansion of the pneumothorax revealed by chest radiography already allows to assess the frequency of recurrence and the incidence of prolonged air fistula, as prospectively demonstrated by Sayar et al.

By contrast, when the patient receives oxygen supplementation, the absorption rate accelerates times; this effect is particularly prominent when a large volume of gas occupies the pleural cavity 11 , However, caution must be exercised to avoid hypercarbia in patients with COPD 7. Because PSP has a low mortality rate, stable patients can be carefully observed while the gas is absorbed passively from the pleural cavity.

According to ACCP guidelines, clinically stable patients should be observed for hours and can be discharged home if a repeat chest radiograph excludes progression of the pneumothorax, which indicates that the causal lesion has closed.

However, for patients residing far from a hospital or health care center, admission for observation is best. Even if the patient is not admitted, the patient should be provided with careful instructions for follow-up examination within 2 days, depending on the circumstances. Aspiration of a pneumothorax is performed using a small catheter. The catheter is inserted into the pleural cavity and either removed immediately after evacuating the air from the pleural cavity or left inserted while the patient if observed.

When left inserted in the thoracic wall, the catheter is still considered a chest tube despite its small size. ACCP recommends the use of simple aspiration in clinically stable patients diagnosed with PSP whose conditions worsen under observation. The BTS guidelines were established based on a study conducted by Noppen et al. The study compared clinical outcomes in patients diagnosed with PSP who received aspiration with a 16G IV catheter and chest tube insertion 16F or 20F ; there was no difference in therapeutic effectiveness between the two techniques, but the hospitalization duration was reduced in patients receiving simple aspiration.

It is worth noting that the sample size was very small and the treatment protocols of the two groups were quite different, and therefore, it is difficult to conclude that there is no difference between two treatment methods. The BTS guidelines do consider these limitations and recommends performing simple aspiration only at facilities possessing practical experience in the procedure and relevant equipment 6. Further study is required on the therapeutic effectiveness of the simple aspiration and small diameter chest tube placement.

While the ACCP recommends simple aspiration in patients diagnosed with SSP in a very limited manner, BTS recommends the procedure for treating small pneumothorax with mild respiratory symptoms in patients less than 50 years old. After performing simple aspiration, the patient should be hospitalized for observation during recovery.

ACCP recommends the placement of a chest tube in a case of large pneumothorax, regardless of whether the patient is clinically stable or unstable, and that in most instances, patients with a large pneumothorax should be hospitalized. In comparison, BTS recommends placement of a chest tube when the simple aspiration procedure fails to resolve the pneumothorax.

In a clinically stable patient diagnosed with a large pneumothorax or a clinically unstable patient, AACP recommends chest tube placement. BTS also recommends chest tube placement, except in patients diagnosed with a very small pneumothorax cm and no respiratory symptoms. The ACCP does recommend inserting a thick chest tube 24 to 28F in a patient experiencing a large-scale air leak, such as a bronchopleural fistula, or receiving mechanical ventilation. BTS always recommends using a 14F chest tube, as there is no evidence that a thick chest tube F is more clinically effective than a thin chest tube F 7.

The efficacy of suction after the placement of chest tube is not well verified; one study reported that suction was not an effective treatment in patients diagnosed with the primary or the SSP Similarly, in another report, chest tube suction did not affect the severity of lung collapse ACCP recommends suction only when the lung fails to re-expand following chest tube placement and observation. BTS does not recommend suction because of the risk pulmonary edema induced by re-expansion.

The BTS also recommends performing suction at a higher velocity and lower pressure to cm H 2 O 7. Chest tubes should be removed only when a chest radiograph demonstrates re-expansion of lung, complete resolution of the pneumothorax, and no clinical evidence of an ongoing air leak ACCP recommends that any suction in progress be suspended prior to chest tube removal.

However, the two organizations have different recommendations on clamping the chest tube closed before its removal. Those who support clamping express concern for a potential small air leak and feel that clamping may be useful in locating a leak. BTS does not recommend clamping when there is no air leak visible.

However, it recommends additional precautions in observing the patient if clamping is performed 6. Intervention to eliminate the leak is generally recommended if the air leak persists for 2 days up to 14 days 19 , 20 , BTS recommends thoracic surgery if the air leaks persist beyond 2 days or if the lung does not re-expand.

If air leaks caused by spontaneous pneumothorax are allowed to persist, the cost of treatment increases, and the therapeutic success rate of thoracoscopy decreases Although the advantage of surgical treatment is not clearly identified yet, ACCP recommends either parietal pleurectomy and bullectomy, or parietal pleural abrasion of one pleural upper half and bullectomy.

BTS recommends several possible interventions including parietal pleurectomy in addition to parietal pleural abrasion and talc-utilized pleurodesis. ACCP recommends performing pleurodesis, using medications such as talc and doxycycline administered through the chest tube, in cases of primary and SSP if the patient declines surgical intervention or is not a suitable surgical candidate.

Similarly, BTS recommends pleurodesis for patients that are not suitable surgical candidates. Appropriately sized talc may actually reduce the risk of respiratory failure In patients diagnosed with SSP who cannot undergo surgery, outpatient treatment with a Heimlich valve may be considered. Professor and Chair of Thoracic Oncology. Osita Onugha, M. Meet Our Thoracic Experts. Lung Cancer Awareness. Read More Thoracic Articles. After 2 weeks he was cleared to return to baseball and normal activities.

He had his second one on the left side Oct When they removed the chest tube his lung had a small collapse. He was on bed rest for a week after returning home. He continued to have pain and would feel like blisters were rubbing and popping. His right lung collapsed in Nov He was admitted with a chest tube to reinflate the lung. When they removed the tube his lung collapsed again. So he had the same surgery on his right lung.

It has now been 2 years since surgery on the left lung and almost a year for the right lung. He continues to suffer with pain. Sometimes it is excruciating, and sometimes he says it is just aggravating. We have been back to the ER and they say he has had another blister pop. He just recently had a CT scan and it shows that he still has blebs. He has exercise induced asthma and is getting bronchitis more often. Sometimes coughing up blood with the bronchitis.

The biopsy from his right lung showed bleb with associated scar and chronic inflammation reactive pleural surface mesothelial changes. What does this mean? Could he have an underlying disease that has caused this? With his history of asthma, frequent bronchitis and multiple pneumothoraces, I would suspect he has a serious underlying lung disease but his pulmonologist should have sorted that out for you by now.

Neurontin, Lyrica or another medication for neuropathies may help with the pain. Chronic inflammation and scarification is part of pleurodesis process, and can be quite painful — but the pain is usually not long-lasting. Thanks for the reply. We have only seen a pulmonologist twice. I am having him tested for CF because it runs in my family. Hunter is skinny but not very tall. He has been the same size all four years of high school. Can you give a recommendation on what I should do and or look for.

Dear Ms. I am not sure where to direct you next — without possible sending you down a dead end or wasting you time. Are you near a large academic institution? Your son might benefit from a university setting, where he could be referred to a pulmonology who specializes in either asthmatic disease or more difficult to diagnose cases, or possibly a rheumatologist or geneticist.

I am sorry I can not give more concrete advice. I previously have had 3 collapsed lungs on the left hand side and on the third time that it happened i had a Mechanical Pleurodesis where the lung is stuck to the chest wall, This was around 9 years ago and last week my lung had collapsed again on the left hand side after those long 9 years which i found very strange after being fine for all that time.

My Cardiothoracic surgeon decided to do a Talc pleurodesis this time after removing some scar tissue from the Mechanical Pleurodesis i had last time hopefully this will keep it together. How can we prevent from creating those blebs and blisters? Sorry for the delay but I was away from the internet for several days. There is no known preventative treatment for blebs unfortunately.

If she smokes, encourage her to quit. I am sorry if this is the case for you. Have been very interesting reading this thread. I suffered my first pneumothorax in June last year.

Despite being a nurse manager on an intensive care unit I completely missed the symptoms and thought my breathlessness was probably due to a chest infection. Thus I carried on for several days until I was back in work. Following a needle aspiration I was discharged but the following day the symptoms had returned and I went back to casualty and had a chest drain inserted and was in hospital for a week.

Following discharge my breathing was never quite right buy xray showed full inflation and I returned to work and my normal activities.

In November I started getting more muscle pain which my GP attributed to compensation. However in December the pneumothorax reoccured and I ended up in hospital again with another chest drain in for a week. I had a pleuradhesive and bullectomy 6 weeks ago. Although it has been quite a painful procedure I now feel I and recovering well and plan to return to work in 2 weeks. One of the best things that I have found to help has been the breathing exercises I was shown by the physiotherapist.

When I experience this I sit for a few minutes and repeat the exercises. To anyone who is going through a similar experience I would say try the surgery and listen to your physio. With correct treatment this can be beaten. Good luck! COPD is more than one illness and includes chronic bronchitis as well as empysema. There are genetic and other factors that make certain people more susceptible to these conditions. Pneumonia and viral illnesses do not generally cause blebs.

I had a pleurodesis following a pleurectomy on my right lung after it failed to respond to normal procedures for re-inflation after a spontaneous collapse. The scar tissue now gives me problems 20 years later with pain and occasional infections. Is there anything I can do about that? When is the last time you had a chest xray and a full evaluation?

Once any other problems have been ruled out — they can evaluate your pain, the appearance of your lungs, as well as your lung function to see what your options are. I have pain from the scar tissue as well 5 yrs post-op. It just flares up for seemingly no reason. This is my second time being diagnosed with TB, mostly in the upper left lung. The first was about 3 to 4 years ago. I was also diagnosed with pulmonay bulla 5cm in diameter a year and a half ago.

I dont have any symptoms except for a pain the the middle of my chest whenever I tilt my head backward completely. I am scared to do a surgery, besides it doesnt really affect me. My question is, how would gyming regular weight lifting just to build some chest and muscles affect my condition. Any other advise with regards to my entire condition and surgery would be welcomed too.

It depends on how badly the TB has damaged your left upper lobe. If it has created large cavitations destroyed sections of lung tissue that becomes infected pockets within the tissue — then surgery might become necessary because large pockets of destroyed lung can cause repeated infections. If you have a large bullae — this could be a cavitary lesion — or a separate lung issue all together. A bullae is another area of nonfunctional lung. Sometimes by removing this bubble, the remaining healthy lung can expand into the removed air and improve breathing.

If you start to have repeated pneumonias, re-visit the issue of surgery — or if you are unable to eradicate the TB. Removing the TB may be your best option, if you fail treatment again. Weight lifting and some aerobic exercise should not worsen your condition unless you are lifting large amounts of heavy weights or have extensive bullae more than one.

If fact, a moderate amount of aerobic exercise running, jogging will actually improve your lung function. Avoid smoking, marijuana smoking or breathing any kind of fumes or chemicals to prevent further lung damage.

I hope you are in contact with an infectious disease specialist as well as a pulmonologist to follow you over time. Thank you very much for the info. I do keep in contact with my TB specialist, but im living in China so the language barrier tends to influence our communication.

So I really appreciate the advice. He is a smoker, but has been trying to quit since his surgery almost a year ago. He had a bullectomy and part of his right upper lobe removed due to it not functioning. We went back to the specialist yesterday after 8 months just for him to tell us my fiances lung is WORSE than it was prior to surgery. He was negative for alpha1. I am looking for what on earth could be possibly making his progression so fast and of course many answers in between.

I apologize for the late reply. Best of luck to the both of you. Thank you for your reply! I agree the smoking needs to stop. As for more information thatsb all we really have been given by the doctors. He had a spontaneous lung collapse in , was told he had blend disease and they decided against surgery. He left the hospital without any referrals to a specialist.

Fast forward three years later he started feeling funny and an ER trip uncovered he was suffering from subcutaneous emphysema in his chest and neck.

After being in and out of the hospital for two months they finally diagnosed him with Bullous Emphysema and did surgery on the right lung, with pending decision to do the left. With no family history of such a condition I am just puzzled how something so serious happened to a 25 year old male. Thank you for your time. Thank you for the additional information. The first step to getting a better understanding of his diagnosis, possible treatments and prognosis is to see a pulmonologist.

He will want spirometry, copies of all xrays, CT scans, bronchoscopies and biopsies, if you have them. He can also prescribe medications that may improve his underlying COPD as well as pulmonary rehabilitation. This should get you off to a good start on your search for answers.

I amm 68 year old male last year I had 5 right lung collapses, then had surgery, the surgen said the bleb was size of tennis ball, he stapled my lung and I had a plurectmy. Out has been six years since I had a collapsed lung. I have been cigarette free for almost a year and want to brave a plane trip across the country.

The doctors said I had blebs. Do you think I should get on an air plane? The existing research states that if you are symptom-free, airline travel should be safe, particularly since it has been several years since your last pneumothorax. Have a good trip! My husband is almost identical. Had a peurodectomy 4 years ago, has blebs and is an ex smoker. We fly several times a year with no issues. One insurance company said he had to be 3 months since his operation, and another said 6 months, but as you have been 6 years, you should be fine.

Your doctor is the best person to answer the question if you are unsure. Any help Pls call on The CT shows one or more blebs not sure how big. The episodes might have coincided with air travel. I used to have fairly severe asthma and only in the last several years really started to enjoy well-functioning lungs.

Now I really appreciate my athletic pursuits, however amateur they may be, and am not anxious to make any compromises on oxygen uptake unless necessary.

I can find very few studies about the impact of pleurodesis or bleb removal on lung function. However the studies are very limited and hard to interpret in more detail. My other option is to keep doing nothing. It seems the episodes have become less frequent maybe. Any useful information on this would be appreciated.

Statistical data aside, is there any mechanism here that would be expected to reduce lung function? Is there any reason to think the lung wall may become less efficient at transferring oxygen, or that the capacity to exchange air would become reduced? Could attachment to the chest wall restrict lung compression or expansion? Is it possible to remove blebs without the pleurodesis?

Is that a bad idea? This is because the chest wall forms adhesions to the lung after most procedures, effectively a pleurodesis. While I understand your concerns, these procedures should not diminish your lung function. If fact, if your blebs are quite large, your lung function may improve since it will allow your lungs to better expand.

I hope this answers your question. The more blebs you have, the more likely you are to have another bleb rupture and cause a pneumothorax. In I had both lungs collapse due to blebs, the surgeon stapled them. I have not had any further issues. My question is by having this done will other issues occur? I have had a wheezing cough for over a year now, is this due to the surgery and will this turn into something more? It sounds like your surgery from 30 years ago has gone well.

I do not think that your cough is related to it — but any cough of long duration should be checked out for other reasons. Please see your family physician regarding this cough.

And if you are a smoker, please stop. I have never smoked and I do have an appointment with a pulmonologist. All my Blebs were stapled due to having so many on both lungs. These stories are so interesting reading that others have had the same problem.

I had a spontaneous pneumothorax 16 years ago when i was 43, it happened as i was landing in an aeroplane. Had a hard job getting it diagnosed, it was only because of my husbands persistance that anyone listened. I think that i have another one now, ive been to the doctors and been told that i have pulled a muscle — she was very patro ising.

I dont know what to do, i havent s lot of energy at the moment, im off work — help. You are commenting using your WordPress. You are commenting using your Google account. You are commenting using your Twitter account. You are commenting using your Facebook account. Notify me of new comments via email. Notify me of new posts via email. Skip to content Overview of spontaneus pneumothorax and treatment modalities.

What are blebs? How is this treated? Simple or first-time pneumothorax Oxygen therapy — traditional treatment for small pneumothorax in asymptomatic or minimally symptomatic patients was oxygen via a face mask or non-rebreather. Interact CardioVasc Thorac Surg 13 5 : Special conditions and circumstances related to Pneumothorax: Catamenial pneumothorax — this a pneumothorax that occurs in menstruating women.

Additional References For more reference citations and articles about the less common causes — see More Blebs, Bullae and Spontaneous Pneumothorax Pneumothorax: an update — gives a nice overview of the different types of pneumothorax, and causes of each.

Early article suggesting VATS for treatment of spontaneous pneumothorax Blebs, Pneumothorax and chest drains [1] Flexible scopes are usually preferred for GI procedures such as colonoscopy, where the camera is inserted into a soft tissue orifice.

Like this: Like Loading Author: K Eckland World of Thoracic Surgery is a blog about the work, research, and practices of thoracic surgeons around the world. Jeremy, All of the research articles are available on pubmed — and I usually post links to the original articles to help readers like yourself. I hope this information helps. Hope this information is helpful. These air-filled sacks can grow quite quickly like blowing bubbles in gum for some people.

Any input is much appreciated. Janet — If his pain is worsening instead of getting better bring his back to his physician. Thanks, Rob. Janet — Multiple studies including meta-analyses and reviews have provided mixed results with vitamin B providing modest or no benefit to patients. Dru — Best of luck to you and your daughter. Dru — Have you discussed the results with your pulmonologist? Mingus — Have you had a second opinion? Regards, and see ya on the hardwood…. Dear Jay, Thank you for your information and advice above.

Your story is an inspiration and I hope to be as impressive in later years. Regards, Yolanda. Take care, all my best, jay. Drew, Have you had spontaneous pneumothorax in the past? Anderson, You are not out-of-line by any means. Hello, Thank you so much for putting this blog together and keeping it going I would be lost without this. Genevieve yes.. Thank you for any of your experiences or advice. Smith, With his history of asthma, frequent bronchitis and multiple pneumothoraces, I would suspect he has a serious underlying lung disease but his pulmonologist should have sorted that out for you by now.

Kristin, Thanks for the reply.