Clinical Review

Spontaneous pneumothorax

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g2928 (Published 08 May 2014) Cite this as: BMJ 2014;348:g2928

This article has a correction. Please see:

  1. Oliver Bintcliffe, clinical research fellow,
  2. Nick Maskell, consultant respiratory physician
  1. 1Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK
  1. Correspondence to: N Maskell nick.maskell{at}bristol.ac.uk

Summary points

  • Primary spontaneous pneumothorax is associated with smoking but defined as occurring in the absence of known lung disease

  • Secondary spontaneous pneumothorax occurs in the presence of known lung disease and is associated with increased symptoms, morbidity, and rates of tension pneumothorax

  • Immediate recognition and management of tension pneumothorax is required to prevent death

  • Smoking increases the risk of pneumothorax and rates of recurrence, and smoking cessation is strongly advised

  • Surgical intervention is warranted for patients with recurrent pneumothorax as the risk of further recurrence is high

Pneumothorax describes the presence of gas within the pleural space, between the lung and the chest wall. It remains a globally important health problem, with considerable associated morbidity and healthcare costs. Without prompt management pneumothorax can, occasionally, be fatal. Current research may in the future lead to more patients receiving ambulatory outpatient management. This review explores the epidemiology and causes of pneumothorax and discusses diagnosis, evidence based management strategies, and possible future developments.

Sources and selection criteria

We searched the Cochrane database of systematic reviews for articles related to pneumothorax. We searched Medline using the search term “pneumothora*” appearing in relevant study types (clinical trials, literature reviews, and meta-analyses) as well as in recent conference proceedings. We limited studies to those in adults. We focused on randomised controlled trials, systematic reviews, and meta-analyses, and where possible used recent studies. The most up to date versions of relevant guidelines (British Thoracic Society, American College of Chest Physicians) were reviewed, as was information from clinicalevidence.bmj.com and uptodate.com.

How common is pneumothorax?

Between 1991 and 1995 annual consultation rates for pneumothorax in England were reported as 24/100 000 for men and 9.8/100 000 for women, and admission rates were 16.7/100 000 and 5.8/100 000, respectively, in a study analysing three national databases.1 The overall incidence represents a rate of one pneumothorax a year …

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