Spontaneous Pneumothorax Causes and Management

Patient Characteristics and Risk Factors

The presence of subpleural blebs and bullae is found in up to 90% of cases during thoracoscopy or thoracotomy and in up to 80% of cases in computed tomography scans, according to the British Thoracic Society 1
Smoking is a primary risk factor, with a lifetime risk of developing pneumothorax of 12% in male smokers compared to 0.1% in non-smokers, as stated by the American College of Chest Physicians 1
Male sex has an incidence of 18-28/100,000 per year in men versus 1.2-6/100,000 per year in women, according to the European Respiratory Society 1
There is no apparent relationship between physical activity and the onset of pneumothorax, as noted by the American Thoracic Society 1

Chronic obstructive pulmonary disease (COPD) is a common underlying condition, as stated by the Global Initiative for Chronic Obstructive Lung Disease 1
HIV/AIDS infection, especially associated with Pneumocystis carinii pneumonia (PCP), is a significant underlying condition, according to the Centers for Disease Control and Prevention 2
Cystic fibrosis is associated with more severe and potentially life-threatening disease, as noted by the Cystic Fibrosis Foundation 2
Pulmonary tuberculosis is a historically important cause, as stated by the World Health Organization 1

Clinical history and physical examination generally suggest the presence of pneumothorax, although clinical manifestations are not reliable indicators of size, as stated by the American College of Radiology 3
Clinical symptoms associated with secondary pneumothorax are generally more severe than those associated with primary pneumothorax, according to the European Respiratory Society 3
Routine use of expiratory chest radiographs is not recommended for the diagnosis of small pneumothorax, as noted by the American College of Chest Physicians 1
A lateral or lateral decubitus chest radiograph should be performed if clinical suspicion of pneumothorax is high but the PA radiograph is normal, as stated by the American Thoracic Society 3
Computed tomography (CT) is recommended to differentiate pneumothorax from complex bullous lung disease, according to the Society of Thoracic Radiology 3

Treatment should be more aggressive in cases of secondary pneumothorax due to its greater severity and risk of complications, as stated by the American College of Chest Physicians 2
Emphasis should be placed on the relationship between pneumothorax recurrence and smoking to encourage patients to quit smoking, as noted by the American Thoracic Society 1
Patients should avoid air travel until a chest radiograph confirms complete resolution of the pneumothorax, as stated by the Federal Aviation Administration 2
Scuba diving should be avoided permanently after a pneumothorax, unless the patient has undergone bilateral surgical pleurectomy, as recommended by the Divers Alert Network 2