Pneumothorax

Pneumothorax, also called collapsed lungs, is a condition in which air escapes from inside the lungs into the cavity between the lungs and the chest wall.

The air that has leaked into the cavity presses the lungs and prevents them from expanding when air is inhaled.

Generally, only a portion of the lungs is collapsed. It might occur due to some blunt or penetrating force on the lungs, certain medical procedures, certain lung diseases, or on its own.

Pneumothorax is the presence of air in the pleural cavity. The pleura is said to be a double-layered protective covering that lines the outside of the lungs as well as the inside of the chest cavity. The pleural cavity is the space in between the layers of the pleura; this separates the lungs from the wall of the chest. When the chest wall is affected, it is called an open pneumothorax, whereas when the lung wall is impacted, it is called a tension pneumothorax. The change in pressure caused by the opening in the walls of the chest or the lungs can result in the collapsing of the lung, as well as pressure on the heart.

Common symptoms include shortness of breath and sudden chest pain.

A small pneumothorax may heal on its own while a larger pneumothorax requires medical attention and can sometimes be life-threatening. The treatment required depends on the severity of the condition. When there is a small amount of air trapped in the pleural spaces, it can point towards tension pneumothorax, which can heal on its own and would not lead to further complications. However, if there is a more serious case, wherein large volumes of air are involved, it can cause life-threatening issues or even become fatal if not treated in a timely manner or if left untreated entirely. Usually, watchful waiting of the symptoms accompanied by complete rest are the most important treatment. These can be done followed by a surgical procedure, administration of oxygen, if required, and insertion of chest tubes based on the severity of the condition and the age of the individual.

The common symptoms of pneumothorax are sudden chest pain and difficulty breathing. In pneumothorax, the patient will usually complain of a dry cough, sudden breathlessness, and sudden chest pain that becomes excessive and may worsen when there is an increase in the inhalation of air. In some cases, air enters the pleural cavity, but does not pass or escape from it, which is often caused due to tension in pneumothorax. Such conditions need to be treated urgently. Also, the individual can experience changes in skin color (bluish discoloration), lowering of blood pressure with an increase in heart and pulse rate, and rapid breathing.

These symptoms are non-specific and could be indicative of various other health conditions. So, if you experience a gradual increase in shortness of breath and severe chest pain, seek immediate medical care.

Types of Pneumothorax

There are various types of pneumothorax that have their own set of symptoms:

• Spontaneous pneumothorax: There are no known signs or symptoms relating to spontaneous pneumothorax until there is a rupture in the bleb leading to pneumothorax. One would experience a sudden onset of acute chest pain accompanied by shortness of breath.
• Tension pneumothorax: In this kind of pneumothorax, the individual would experience symptoms such as chest pain, hypoxia, and dyspnea.
• Latrogenic pneumothorax: In this type of pneumothorax, the symptoms are very similar to those seen in spontaneous pneumothorax, such as chest pain and shortness of breath. However, the severity of the symptoms can vary, or additional symptoms could flare up depending on the age of the individual, the extent of the pneumothorax, and the presence of any underlying disease related to the lungs.
• Catamenial pneumothorax: Women in the age range of thirty to forty years notice symptoms within the first forty-eight hours of menstruation and recurrence.

A pneumothorax can result from various causes, including:

• Injury to the lungs: Any chest injury, blunt or penetrating, can cause lung collapse. These may occur during a physical assault or road traffic accident. Less commonly, surgical procedures that involve the use of needles in the chest cavity can also cause collapsed lungs. It can also occur due to a fractured rib. Individuals who are tall and thin have small air-filled sacs in the lungs called blebs or blisters. These blebs can rupture, which would lead to leakage of air in the pleural cavity and cause spontaneous pneumothorax.
• Lung disease: Lung diseases like COPD (chronic obstructive pulmonary disease), cystic fibrosis, tuberculosis, and whooping cough can weaken the lung tissues and make them more prone to collapse. Alcohol abuse and smoking can also worsen the condition and lead to an increased risk.
• Mechanical ventilation: Mechanical ventilators can interfere with the normal air balance in the chest and lead to pneumothorax. In certain people, a severe type of pneumothorax may occur, thus requiring mechanical assistance to breathe normally. This ventilator can also lead to an imbalance in the air pressure within the chest area, thus leading to a complete collapse of the lungs.

• Ruptured air blisters: Changes in pressure during scuba diving or mountain climbing can cause air bubbles to develop in the lungs, which can rupture through weak areas in the lining of the lungs and lead to air leaking into the chest cavity.

Seek a Doctor’s Attention

Since pneumothorax can occur due to various causes or trauma to the lung, in such cases, the person should seek medical attention immediately if there is any trouble breathing. However, there are other medical conditions that can also lead to difficulty breathing, hence, an accurate diagnosis is needed before starting treatment. If breathing becomes increasingly difficult, it is considered an emergency, however, such instances are rare.

Questions to ask the doctor include:

• What are the likely reasons causing the symptoms?
• What kind of tests need to be carried out to diagnose the correct condition?
• If there are any other existing health conditions, how can they be managed together?
• What is the course of action recommended for this condition?
• Are there any restrictions to follow to keep it from worsening?

A diagnosis of pneumothorax begins with a physical examination to find out if breathing is normal. Your doctor may also use a stethoscope to listen to one’s breathing.

In addition, the doctor may recommend the following:

• Chest X-ray: A chest X-ray can be used to determine the size of the pneumothorax.
• CT scan: A CT scan is the gold standard in pneumothorax diagnosis. It uses numerous X-rays to create detailed images of the lungs, and even small pneumothorax are detectable.
• Electrocardiogram

If only a small area of the lung is affected, you may not require any treatment for pneumothorax. The goal of treatment is to restore the expansion of the lungs by reducing pressure. In some cases, the treatment can be directed to prevent pneumothorax from reoccurring. The choice of treatment depends on the severity of the lung collapse and one’s general health.

Treatment involves:

• Observation: If the size of pneumothorax is small, you may not need special treatment; instead, monitoring through several X-rays over a period of one to two weeks is recommended.
• Needle or chest tube insertion: If the pneumothorax has affected a larger area, your doctor will insert a hollow needle or tube between the ribs into the air-filled space that is pressing on the collapsed lung. Then, the doctor will use a syringe to pull out the excess air. A chest tube may be attached to a suction device that continuously pulls out air from the chest cavity.
• Surgery: In severe pneumothorax, surgery may be recommended to seal the air leak.
• Complete bed rest: When the doctor says the patient should go in for complete bed rest, it also means one would need to keep a watchful eye on the symptoms and the body’s response to the treatment, if any. When only a small area of the lung is affected, bed rest would be the likely treatment option, however, the doctor would regularly monitor the condition to check the air absorbed from the space in the pleural. There would also be frequent X-rays taken to check and ensure the lung has expanded again. One would be told to avoid any kind of physical strain or strenuous activity to speed up the healing process.
• Pleurodesis: This is an invasive form of treatment which would be provided by the doctor if both lungs collapsed so as to prevent the pneumothorax from occurring again. During this process, the doctor would first destroy the pleural space to stop the air and any kind of fluids from building up in the space. The process of pleurodesis is done to make the lungs’ membranes stick together. Once the pleura is joined together, the space would no longer be there, which would prevent pneumothorax. One can also go in for the mechanical process of pleurodesis, wherein the surgeon would gently rub the pleura to cause inflammation. Another form of pleurodesis is the chemical one, wherein chemical irritants are delivered into the pleura via a chest tube. This then leads to inflammation and irritation and causes the joining of pleura.

No measures have been shown to prevent pneumothorax, but some measures can lower one’s risk of developing pneumothorax:

• Cessation of smoking
• Wearing a seatbelt during driving to prevent an accidental bump in the chest
• Exercising extra precaution if you have other lung diseases
• People with a history of pneumothorax are recommended to avoid mountain climbing and scuba diving, as pressure changes during these activities can also cause pneumothorax.

There are several risks and complications associated with pneumothorax. Risks include:

• Gender: In general, men are at a greater risk of developing pneumothorax than women.
• Smoking: Risk increases with the duration of smoking and the number of cigarettes smoked.
• Age: Pneumothorax due to rupture of air bubbles in the lungs is most commonly found in individuals between twenty and forty years. This risk further increases in tall and thin people.
• Genetics: Some types of pneumothorax may be inherited.
• Lung disease: If you already suffer from some kind of lung disease, especially chronic obstructive pulmonary disease (COPD), you are more likely to have pneumothorax.
• Mechanical ventilation: Mechanical ventilators can interfere with the air balance in the lungs and lead to pneumothorax.
• Previous pneumothorax: A previous incidence of pneumothorax raises the risk of another occurrence of collapsed lungs.

One pneumothorax may lead to another pneumothorax, usually within one to two years. Sometimes, surgery is needed to close the leak if it is large and if air continues to pass into the chest cavity.