Respiratory[autotexts]

Pleural disease / Patient information

Pneumothorax - information for patients

What a collapsed lung is, what happens next, and the rules about flying, diving and smoking that people are rarely told clearly.

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About your pneumothorax

A pneumothorax is a collection of air between the lung and the chest wall. The
air takes up space, so the lung cannot expand fully. People often call it a
collapsed lung.

It happens when a small air leak develops on the surface of the lung. In
younger, taller people this often occurs without any injury or warning, from a
small bleb on the lung surface. In people with existing lung disease, such as
emphysema, it can happen because the lung tissue is already fragile.

Air that leaks out is gradually reabsorbed by the body once the leak seals.

What happens next

Treatment depends on how big the pneumothorax is, how breathless you are, and
whether you have other lung disease. Options are:

Observation. If you are not very breathless and the pneumothorax is small,
doing nothing except watching is often the best treatment. The air reabsorbs on
its own over days to a few weeks.

Aspiration. Air is drawn out through a needle under local anaesthetic.

A chest drain. A tube is placed between the ribs under local anaesthetic to let
the air out continuously, usually needing a stay in hospital.

Some people are suitable for a small device that lets them go home with the
drain in place. We will tell you if that applies to you.

Surgery. If the leak does not seal, or if the pneumothorax comes back, an
operation can seal the surface of the lung and stick it to the chest wall.

Your plan: []

After you go home

You may have some chest discomfort for a while. Simple painkillers usually
help.

Come back to hospital urgently, or call 999, if you become more breathless,
develop worse chest pain, feel faint, or your heart is racing. A pneumothorax
can enlarge again, and it can do so quickly.

Smoking

If you smoke, stopping matters more here than almost anywhere else. Smoking
substantially increases the chance of a pneumothorax happening again. We can
arrange support and medication, and this is the single most useful thing you
can do to avoid going through this a second time.

Flying

Do not fly until the pneumothorax has fully resolved and this has been
confirmed on a chest x-ray. Current guidance is that flying is reasonable once
the x-ray confirms resolution and you have recovered, and your team will tell
you the interval they advise. Check with your insurer as well.

Diving

Do not scuba dive again unless you have had surgery to prevent recurrence and
have been assessed as fit to dive. This is a permanent restriction otherwise,
and it is not a formality: a pneumothorax at depth can be fatal.

Coming back

A pneumothorax comes back in a substantial minority of people, most often in
the first year. Knowing the symptoms means you will recognise it quickly.
Sudden breathlessness or sudden one-sided chest pain should be assessed the
same day.

How to use it

Conservative management is now much more prominent than it was, so the block explains observation first and as a treatment rather than as a delay — patients who expect a drain and are sent home otherwise often assume they have been fobbed off. The diving restriction is stated flatly because it is permanent without surgery and is frequently softened into something the patient hears as advisory. Fill in the local interval before flying rather than quoting a number here; guidance varies and your team will have a position.

Why it says that

None of this is in the copied text. It is here so you can check the block against its source, and change it when the source changes.

Trials behind it

  • PSP 2020 Most primary spontaneous pneumothoraces resolved without any intervention, though the non-inferiority result is fragile
  • RAMPP 2020 Ambulatory devices sent most patients home the same day, but caused more adverse events

Records on respiratorytrials.org.

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