Pneumothorax (Collapsed Lung)

What a pneumothorax is

Each lung is surrounded by two thin layers of tissue, the pleura. The space between them normally contains only a film of fluid and has slightly negative pressure, which keeps the lung expanded against the chest wall. If air enters this space, through a leak from the lung or a wound in the chest wall, the lung recoils and collapses partly or completely.

Types of pneumothorax

Tension pneumothorax is a medical emergency needing immediate decompression.

Symptoms

• Sudden sharp, stabbing chest pain on one side, often worse when breathing in. It may spread to the shoulder or back.
• Shortness of breath, ranging from mild to severe.
• Fast breathing and fast heart rate.
• Dry cough.
• Fatigue.

Young people with a small primary pneumothorax may have surprisingly mild symptoms and wait days before seeking help. People with lung disease can become very breathless even from a small one, because they have little lung reserve.

Signs of tension pneumothorax include severe breathlessness, very fast heart rate, low blood pressure, bluish skin, distended neck veins and confusion.

Risk factors

• Smoking: increases the risk of primary spontaneous pneumothorax many times over, including smoking cannabis.
• Tall, thin build and male sex.
• Lung disease: COPD, cystic fibrosis, severe asthma, tuberculosis, Pneumocystis pneumonia.
• Genetic conditions: Marfan syndrome, Ehlers-Danlos syndrome, Birt-Hogg-Dubé syndrome, and lymphangioleiomyomatosis in women.
• Previous pneumothorax.
• Family history.
• Changes in air pressure, such as diving or, much less often, flying.

Diagnosis

1. Examination: reduced breath sounds and increased resonance on the affected side.
2. Chest X-ray: shows a visible edge of the collapsed lung with no lung markings beyond it. The size is estimated from the gap between lung and chest wall.
3. Ultrasound: fast at the bedside, especially in trauma and intensive care.
4. CT scan: for small or complex cases, to find blebs or underlying lung disease, and to plan surgery.
5. Oxygen levels with a pulse oximeter or blood gas.

Pneumothorax treatment

Treatment depends on symptoms, size, the type and whether you have lung disease. Current guidelines focus more on how you feel than on the exact size.

Observation (conservative management)

For a primary spontaneous pneumothorax with mild symptoms, observation with follow-up X-rays is often safe. The air is absorbed gradually, roughly 1.5 to 2 percent of the lung volume per day. Oxygen in hospital can speed absorption.

Needle aspiration

A thin needle or catheter is placed between the ribs and the air is drawn out with a syringe. This works for many primary pneumothoraxes and avoids a hospital stay.

Chest tube (chest drain)

A tube is inserted between the ribs, under local anesthetic, and connected to a one-way valve or underwater seal. It lets air out continuously until the leak seals, usually within a few days. Small portable valves allow some people to go home with the drain.

Surgery

Surgery is offered for:

• A second pneumothorax on the same side, or a first on the opposite side.
• An air leak lasting more than 3 to 5 days.
• Both lungs affected at once.
• High-risk jobs or hobbies, such as pilots and divers.

Video-assisted thoracoscopic surgery (VATS) removes blebs and roughens or strips the pleura (pleurodesis or pleurectomy), so the layers stick together. This reduces recurrence to under about 5 percent.

Chemical pleurodesis

Talc or other substances are put into the pleural space through a drain to seal it, usually in people with secondary pneumothorax who are not fit for surgery.

Recovery time

After a small pneumothorax, the lung usually re-expands within 1 to 3 weeks. After a chest tube or surgery, most people return to desk work within 1 to 2 weeks. Avoid heavy lifting and contact sports for about 4 to 6 weeks, or as advised.

Flying: wait until a chest X-ray confirms full re-expansion, and then usually about 1 week more before flying.

Scuba diving: generally advised against permanently after a pneumothorax, unless you have had surgery to remove the pleura on both sides.

Recurrence and prevention

About 30 percent of people with a primary spontaneous pneumothorax have another within a few years, mostly in the first year. Recurrence is higher after a secondary pneumothorax. Stopping smoking is the most effective way to reduce the risk.

Frequently asked questions

What does a collapsed lung feel like?

It usually feels like a sudden, sharp, stabbing pain on one side of the chest that worsens when you breathe in, along with shortness of breath. Some people feel tightness, a fast heartbeat or a dry cough. A small one may cause only mild discomfort.

What causes a pneumothorax?

In young, healthy people, small air blisters on the lung surface can burst for no clear reason, especially in tall, thin men and smokers. In others, lung disease such as COPD or cystic fibrosis, chest injuries, or medical procedures cause air to leak around the lung.

Can a collapsed lung heal on its own?

A small pneumothorax with mild symptoms often heals on its own as the body absorbs the air over 1 to 3 weeks. Doctors still monitor it with X-rays. Larger or symptomatic ones usually need the air removed with a needle or chest tube.

How long does it take to recover from a collapsed lung?

Most people recover within 1 to 3 weeks after a small pneumothorax and return to normal activities within a few weeks. After a chest tube or surgery, full recovery takes about 2 to 6 weeks. Avoid flying until a doctor confirms the lung has fully re-expanded.

Can you fly after a pneumothorax?

Yes, once a chest X-ray shows the lung has fully re-expanded, usually with a wait of around a week after that. Flying too early risks the pneumothorax enlarging as cabin pressure falls. Ask your doctor before booking travel.

Will a pneumothorax happen again?

It can. About 1 in 3 people with a primary spontaneous pneumothorax has another, most often within a year. Stopping smoking lowers the risk. Surgery is usually offered after a second episode, and reduces the chance of recurrence to a few percent.