Treatment of Pneumothorax

It is estimated that up to 1,500 New Zealanders present to emergency departments (ED’s) each year, in pain and short of breath, experiencing a collapsed lung, or pneumothorax. This condition can be caused by an underlying lung disease or, more commonly, for no obvious reason at all. It occurs when a spontaneous leak from the surface of the lung causes air to collect inside the chest, which in turn causes pain and breathing difficulties. For decades, standard hospital treatment for a pneumothorax has been interventional, with doctors inserting a plastic tube into the patient’s chest to drain the collected air to help the lung reinflate. Not only is this treatment often painful, but it can also lead to organ injury, bleeding, infection and sometimes additional surgery if the air leak continues.

MRINZ-led research has changed the way doctors all over the world treat pneumothorax. A six-year randomised controlled study identified that a ‘watchful waiting’ approach to the treatment led to better outcomes, being considerably safer than the traditional invasive surgical approach.

It was found that 85% of patients with moderate-to-large spontaneous pneumothorax could be managed without an interventional procedure. Most patients cope well physiologically, even with very large pneumothoraces if the underlying lung is healthy. The findings have caused a major shift in the practice of treating pneumothorax worldwide, allowing patients to go home from the ED instead of being admitted to hospital, thus recovering quicker and avoiding the serious complications associated with an interventional tube procedure.