Skip to main content
Top
Published in: Current Pulmonology Reports 2/2020

01-06-2020 | Pneumothorax | Pleural Diseases and Mesothelioma (H Davies, Section Editor)

Current Management Strategies for Primary Spontaneous Pneumothorax

Authors: Hugh Welch, Steven Walker, Nick Maskell

Published in: Current Pulmonology Reports | Issue 2/2020

Login to get access

Abstract

Purpose of Review

Primary spontaneous pneumothorax is a distressing condition which affects young healthy patients. In this review, we highlight recent advances in the management of primary spontaneous pneumothorax and look to the future with the advent of studies that will have global impact in the area.

Recent Findings

Recent research has taken a step back from immediate invasive interventions which can confine a patient to a hospital bed, exploring instead alternative approaches such as ambulatory management or observation.

Summary

When managing primary spontaneous pneumothoraces acutely, rather than opting for aggressive chest tube drainage, clinicians are encouraged to consider less invasive management options such as conservative observation, aspiration, or insertion of pleural vents. An assessment of the underlying cause of primary spontaneous pneumothorax is essential. Similarly, the clinician must evaluate the risk of recurrence as this influences onward management. In the next few years, we expect further exciting developments emerge that will illuminate these issues further.
Literature
1.
go back to reference Traité du diagnostic des maladies des poumons et du coeur, Tome Second. Laennec RTH, Paris: Brosson and Chaudé, 1819. Traité du diagnostic des maladies des poumons et du coeur, Tome Second. Laennec RTH, Paris: Brosson and Chaudé, 1819.
2.
go back to reference Kjærgaard H. Spontaneous pneumothorax in the apparently healthy. Acta Medica Scand Suppl. 1932;43(3):1–159. Kjærgaard H. Spontaneous pneumothorax in the apparently healthy. Acta Medica Scand Suppl. 1932;43(3):1–159.
3.
go back to reference Macduff A, Arnold A. Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Harvey J Thorax. 2010;65:ii18–31.PubMed Macduff A, Arnold A. Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Harvey J Thorax. 2010;65:ii18–31.PubMed
4.
go back to reference Mitani A, Hakamata Y, Hosoi M, Horie M, Murano Y, Saito A, et al. The incidence and risk factors of asymptomatic primary spontaneous pneumothorax detected during health check-ups. BMC Pulm Med. 2017;17(1):177.CrossRefPubMedPubMedCentral Mitani A, Hakamata Y, Hosoi M, Horie M, Murano Y, Saito A, et al. The incidence and risk factors of asymptomatic primary spontaneous pneumothorax detected during health check-ups. BMC Pulm Med. 2017;17(1):177.CrossRefPubMedPubMedCentral
7.
go back to reference Mitlehner W, Friedrich M, Dissmann W. Value of computer tomography in the detection of bullae and blebs in patients with primary spontaneous pneumothorax. Respiration. 1992;59:221–7.CrossRefPubMed Mitlehner W, Friedrich M, Dissmann W. Value of computer tomography in the detection of bullae and blebs in patients with primary spontaneous pneumothorax. Respiration. 1992;59:221–7.CrossRefPubMed
8.
go back to reference Computed tomography in the etiologic assessment of idiopathic spontaneous pneumothorax. Lesur, Olivier, Fromaget, Jean Michel et al. Chest, Volume 98, Issue 2, 341–347. Computed tomography in the etiologic assessment of idiopathic spontaneous pneumothorax. Lesur, Olivier, Fromaget, Jean Michel et al. Chest, Volume 98, Issue 2, 341–347.
9.
go back to reference Pathogenesis of spontaneous pneumothorax, Ohata M, et al. Chest. 77(6):771–6. Pathogenesis of spontaneous pneumothorax, Ohata M, et al. Chest. 77(6):771–6.
10.
go back to reference Lee, Sungsoo et al. Staple line coverage after bullectomy for primary spontaneous pneumothorax: a randomized trial. The Annals of Thoracic Surgery, Volume 98, Issue 6, 2005–2011. Lee, Sungsoo et al. Staple line coverage after bullectomy for primary spontaneous pneumothorax: a randomized trial. The Annals of Thoracic Surgery, Volume 98, Issue 6, 2005–2011.
11.
go back to reference Lesur O, Delorme N, Polu JM, Fromaget JM, Bernadec P. Computed tomography in the etiologic assessment of idiopathic spontaneous pneumothorax. Chest. 1990;98(2):341–7.CrossRefPubMed Lesur O, Delorme N, Polu JM, Fromaget JM, Bernadec P. Computed tomography in the etiologic assessment of idiopathic spontaneous pneumothorax. Chest. 1990;98(2):341–7.CrossRefPubMed
12.
go back to reference Casali C, Stefani A, Ligabue G, Natali P, Aramini B, Torricelli P. Role of blebs and bullae detected by high-resolution computed tomography and recurrent spontaneous pneumothorax. Morandi UAnn Thorac Surg. 2013;95(1):249–55.CrossRef Casali C, Stefani A, Ligabue G, Natali P, Aramini B, Torricelli P. Role of blebs and bullae detected by high-resolution computed tomography and recurrent spontaneous pneumothorax. Morandi UAnn Thorac Surg. 2013;95(1):249–55.CrossRef
13.
go back to reference Primavesi F, Jager T, Meissnitzer T, Buchner S, Reich-Weinberger S, Ofner D, et al. First episode of spontaneous pneumothorax: CT-based scoring to select patients for early surgery. World J Surg. 2016;40:1112.CrossRefPubMed Primavesi F, Jager T, Meissnitzer T, Buchner S, Reich-Weinberger S, Ofner D, et al. First episode of spontaneous pneumothorax: CT-based scoring to select patients for early surgery. World J Surg. 2016;40:1112.CrossRefPubMed
14.
go back to reference Li, Xiang et al. Deep learning-enabled system for rapid pneumothorax screening on chest CT. European Journal of Radiology, Volume 120, 108692. Li, Xiang et al. Deep learning-enabled system for rapid pneumothorax screening on chest CT. European Journal of Radiology, Volume 120, 108692.
15.
go back to reference • Bintcliffe O, Edey A, Armstrong L, Negus I, Maskell N. Parenchymal assessment in primary and secondary pneumothorax. Lung Ann Am Thorac Soc. 2016;13(3):350–5 A 2016 study showing radiological evidence of underlying lung disease including ELCs in the majority of patients defined as having primary spontaneous pneumothorax.CrossRefPubMed • Bintcliffe O, Edey A, Armstrong L, Negus I, Maskell N. Parenchymal assessment in primary and secondary pneumothorax. Lung Ann Am Thorac Soc. 2016;13(3):350–5 A 2016 study showing radiological evidence of underlying lung disease including ELCs in the majority of patients defined as having primary spontaneous pneumothorax.CrossRefPubMed
16.
go back to reference Chen CK, Chen P, Huang HC, Lin YS, Fang HY. Overexpression of matrix metalloproteinases in lung tissue of patients with primary spontaneous pneumothorax. Respiration. 2014;88(5):418–25.CrossRefPubMed Chen CK, Chen P, Huang HC, Lin YS, Fang HY. Overexpression of matrix metalloproteinases in lung tissue of patients with primary spontaneous pneumothorax. Respiration. 2014;88(5):418–25.CrossRefPubMed
17.
go back to reference Huang YF, Chiu WC, Chou SH, Su YH, Chen YW, Chai CY, et al. Association of MMP-2 and MMP-9 expression with recurrences in primary spontaneous pneumothorax. Kaohsiung J Med Sci. 2017;33(1):17–23.CrossRefPubMed Huang YF, Chiu WC, Chou SH, Su YH, Chen YW, Chai CY, et al. Association of MMP-2 and MMP-9 expression with recurrences in primary spontaneous pneumothorax. Kaohsiung J Med Sci. 2017;33(1):17–23.CrossRefPubMed
18.
go back to reference Abolnik IZ, Lossos IS, Zlotogora J, Brauer R. On the inheritance of primary spontaneous pneumothorax. Am J Med Genet. 1991;40:155–8.CrossRefPubMed Abolnik IZ, Lossos IS, Zlotogora J, Brauer R. On the inheritance of primary spontaneous pneumothorax. Am J Med Genet. 1991;40:155–8.CrossRefPubMed
19.
go back to reference Scott RM, Henske EP, Raby B, et al. Familial pneumothorax: towards precision medicine. Thorax. 2018;73:270–6.CrossRefPubMed Scott RM, Henske EP, Raby B, et al. Familial pneumothorax: towards precision medicine. Thorax. 2018;73:270–6.CrossRefPubMed
20.
go back to reference Pavlovich CP, Grubb RL, Hurley K, et al. Evaluation and management of renal tumors in the Birt-Hogg-Dubé syndrome. J Urol. 2005;173:1482–6.CrossRefPubMed Pavlovich CP, Grubb RL, Hurley K, et al. Evaluation and management of renal tumors in the Birt-Hogg-Dubé syndrome. J Urol. 2005;173:1482–6.CrossRefPubMed
21.
go back to reference Tschopp JM, Bintcliffe O, Astoul P. ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax. Our Respir J. 2015;46:321–35.CrossRef Tschopp JM, Bintcliffe O, Astoul P. ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax. Our Respir J. 2015;46:321–35.CrossRef
22.
go back to reference Baumann MH, Strange C, Heffner JE, et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest. 2001;119:590–602.CrossRefPubMed Baumann MH, Strange C, Heffner JE, et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest. 2001;119:590–602.CrossRefPubMed
23.
go back to reference Contou D, Schlemmer F, Maitre B, et al. Management of primary spontaneous pneumothorax by intensivists: an international survey. Intensive Care Med. 2016;42:1508–10.CrossRefPubMed Contou D, Schlemmer F, Maitre B, et al. Management of primary spontaneous pneumothorax by intensivists: an international survey. Intensive Care Med. 2016;42:1508–10.CrossRefPubMed
24.
25.
go back to reference • Thelle A, Gjerdevik M, Suechu M, et al. Randomised comparison of needle aspiration and chest tube drainage in spontaneous pneumothorax. Eur Respir J. 2017;49:1601296. https://doi.org/10.1183/13993003.01296-2016]Recently reported RCT that showed reduced tenth of stay and complication rates in patients with spontaneous pneumothorax managed with needle aspiration compared with hose managed with chest tube drainage.CrossRefPubMed • Thelle A, Gjerdevik M, Suechu M, et al. Randomised comparison of needle aspiration and chest tube drainage in spontaneous pneumothorax. Eur Respir J. 2017;49:1601296. https://​doi.​org/​10.​1183/​13993003.​01296-2016]Recently reported RCT that showed reduced tenth of stay and complication rates in patients with spontaneous pneumothorax managed with needle aspiration compared with hose managed with chest tube drainage.CrossRefPubMed
26.
go back to reference Bintcliffe OJ, Hallifax RJ, Edey A. Spontaneous pneumothorax: time to rethink management? Lancet Respir Med. 2015;3:578–88.CrossRefPubMed Bintcliffe OJ, Hallifax RJ, Edey A. Spontaneous pneumothorax: time to rethink management? Lancet Respir Med. 2015;3:578–88.CrossRefPubMed
28.
go back to reference • Hallifax RJ, Laskawiec-Szkonter M, Rahman NM, on behalf of The RAMPP Trial collaborators. Predicting outcomes in primary spontaneous pneumothorax using air leak measurements. Thorax. 2019;74:410–2 Interim subgroup analysis of the RAMPP trial suggesting air leak can be used as a predictor of failure of medical management of PSP.PubMed • Hallifax RJ, Laskawiec-Szkonter M, Rahman NM, on behalf of The RAMPP Trial collaborators. Predicting outcomes in primary spontaneous pneumothorax using air leak measurements. Thorax. 2019;74:410–2 Interim subgroup analysis of the RAMPP trial suggesting air leak can be used as a predictor of failure of medical management of PSP.PubMed
30.
go back to reference • Brown SGA, Ball EL, Perrin K, et al. Conservative versus interventional treatment for spontaneous pneumothorax. N Engl J Med. 2020;382:405–15 RCT comparing conservative PSP management to chest tube drainage.CrossRefPubMed • Brown SGA, Ball EL, Perrin K, et al. Conservative versus interventional treatment for spontaneous pneumothorax. N Engl J Med. 2020;382:405–15 RCT comparing conservative PSP management to chest tube drainage.CrossRefPubMed
31.
go back to reference Foroulis CN, Anastasiadis K, Charokopos N, et al. A modified two-port thoracoscopic technique versus axillary minithoracotomy for the treatment of recurrent spontaneous pneumothorax: a prospective randomized study. Surg Endosc. 2012;26:607–14.CrossRefPubMed Foroulis CN, Anastasiadis K, Charokopos N, et al. A modified two-port thoracoscopic technique versus axillary minithoracotomy for the treatment of recurrent spontaneous pneumothorax: a prospective randomized study. Surg Endosc. 2012;26:607–14.CrossRefPubMed
32.
go back to reference Schramel FM, Postmus PE. Current aspects of spontaneous pneumothorax. Vanderschueren RG Eur Respir J. 1997;10(6):1372–9.CrossRefPubMed Schramel FM, Postmus PE. Current aspects of spontaneous pneumothorax. Vanderschueren RG Eur Respir J. 1997;10(6):1372–9.CrossRefPubMed
33.
go back to reference Yuan Huei Huang, Pei Yeh Chang, Kin Sun Wong, Chee Jen Chang, Jin Yao Lai, Jeng Chang Chen, An age-stratified longitudinal study of primary spontaneous pneumothorax. J Adolesc Health, 61, 4, 2017. Yuan Huei Huang, Pei Yeh Chang, Kin Sun Wong, Chee Jen Chang, Jin Yao Lai, Jeng Chang Chen, An age-stratified longitudinal study of primary spontaneous pneumothorax. J Adolesc Health, 61, 4, 2017.
35.
go back to reference Bobbio A, Dechartres A, Bouam S, et al. Epidemiology of spontaneous pneumothorax: gender-related differences. Thorax. 2015;70:653–8.CrossRefPubMed Bobbio A, Dechartres A, Bouam S, et al. Epidemiology of spontaneous pneumothorax: gender-related differences. Thorax. 2015;70:653–8.CrossRefPubMed
38.
go back to reference Bendixen M, Jørgensen OD, Kronborg C, Andersen C, Licht PB. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol. 2016;17(6):836–44.CrossRefPubMed Bendixen M, Jørgensen OD, Kronborg C, Andersen C, Licht PB. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol. 2016;17(6):836–44.CrossRefPubMed
39.
go back to reference Ng C, Maier HT, Kocher F, et al. VATS partial pleurectomy versus VATS pleural abrasion: significant reduction in pneumothorax recurrence rates after pleurectomy. World J Surg. 2018;42(10):3256–62.CrossRefPubMedPubMedCentral Ng C, Maier HT, Kocher F, et al. VATS partial pleurectomy versus VATS pleural abrasion: significant reduction in pneumothorax recurrence rates after pleurectomy. World J Surg. 2018;42(10):3256–62.CrossRefPubMedPubMedCentral
Metadata
Title
Current Management Strategies for Primary Spontaneous Pneumothorax
Authors
Hugh Welch
Steven Walker
Nick Maskell
Publication date
01-06-2020
Publisher
Springer US
Published in
Current Pulmonology Reports / Issue 2/2020
Electronic ISSN: 2199-2428
DOI
https://doi.org/10.1007/s13665-020-00249-9