lung and airway disorders
Pneumothorax
Treatment of Pneumothorax
Air removal A small, primary spontaneous pneumothorax usually requires no treatment. It usually does not cause serious breathing problems, and the air is absorbed in several days. The full absorption of air in a larger pneumothorax may take 2 to 4 weeks. However, the air can be removed more quickly by inserting a catheter or chest tube into the pneumothorax. If a primary spontaneous pneumothorax is large enough to make breathing difficult, the air can be removed (aspirated) with a large syringe attached to a thin flexible tube (catheter) inserted into the chest. The catheter can be removed or sealed and then left in place for a time so that any air that reaccumulates can be removed. People with primary spontaneous pneumothoraces should stop smoking and may benefit from Smoking Cessation counseling. A chest tube may be used to drain the air if catheter aspiration is unsuccessful and when any other type of pneumothorax (such as a secondary spontaneous pneumothorax or a traumatic pneumothorax) occurs. The chest tube is inserted through an incision in the chest wall and is connected to a water-sealed drainage system or a one-way valve that allows the air to exit without allowing any air to get back in. A suction pump may be attached to the chest tube if air keeps leaking in from an abnormal connection (fistula) between an airway and the pleural space. Occasionally, surgery is necessary. Often the surgery is done by using a thoracoscope inserted through the chest wall and into the pleural space. A recurring pneumothorax can cause considerable disability. Surgery can be done to prevent pneumothorax from recurring. Usually surgery involves repairing leaking areas of the lung, firmly attaching the inner layer of pleura to the outer layer. This surgery is usually done by using a Thoracoscopy (a tube that allows doctors to view the pleural space). People who may need the surgery include People at high risk—for example, divers and airplane pilots—after the first episode of pneumothorax People who have secondary spontaneous pneumothorax—after the first episode of pneumothorax, if the person is healthy enough to undergo surgery People who have a pneumothorax that will not heal or a pneumothorax that has occurred twice on the same side If a person with recurring pneumothorax cannot tolerate surgery because of poor health, the pleural space can be sealed by administering a talc mixture or the drugdoxycyclinethrough a chest tube that is draining air from the space. However, sealing the space this way is less effective than surgery. When sealed this way, pneumothorax eventually develops again in 15% of people. In contrast, when surgery is done, pneumothorax develops again in only 5% of people. 