Pneumothorax Symptoms, Causes & Treatment

Pneumothorax is when air or gas leaks into the pleural space separating the lung from the chest wall, causing the lung to collapse, and leading to sharp chest pain.

What Is Collapsed Lung (Pneumothorax)?

A pneumothorax occurs when air or gas leaks into the space (called the pleural space), separating the lung from the chest wall. It puts pressure on the lung, causing the lung to collapse.

Symptoms include sudden, sharp chest pain that worsens with deep breathing, shortness of breath, a faster heart rate, fatigue, and bluish skin.

Treatments include methods to remove air from the pleural space, reducing pain associated with breathing, as well as measures to keep the lung from collapsing, which may include surgery.

You should go to the ER immediately as a pneumothorax can de-stabilize your ability to breathe and your blood flow from the heart. Diagnosis involves an immediate chest x-ray. Confirmation leads to different decisions on whether to treat the pneumothorax or let it heal naturally under doctor supervision.

Collapsed Lung (Pneumothorax) Symptoms

Symptoms can be divided into those that affect the chest and those that are more general that can affect the entire body.

Chest-related symptoms

Chest-related symptoms include:

  • Chest pain: The abnormal presence of air in the pleural space irritates the surrounding tissues, causing sudden, sharp chest pain that worsens with deep breaths.
  • Shortness of breath: Since a pneumothorax means your lungs do not fill to their normal capacity, you feel out of breath easily and breathe faster than normal.
  • Faster heart rate (tachycardia): Your heart will beat faster to try to maintain oxygen delivery to the body.

Other symptoms

Due to the effects on circulation and breathing, you may also experience:

  • Fatigue: With less oxygen than normal, you will feel tired.
  • Bluish skin: Since the lungs are not able to function at their full capacity, your tissues may not get as much oxygen as normal, leading your skin to appear bluish, especially at the lips and fingertips.

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Collapsed Lung (Pneumothorax) Causes

Your lungs fill a compartment in your chest known as the thorax. Normally the lungs fill the entire thorax so that the outer lining of your lungs comes into direct contact with the innermost lining of your chest, with nothing in the space between the two linings. A pneumothorax is primarily caused by when air leaks into the pleural space.

Ways that air can get into the pleural space include primary, or sudden causes, and secondary causes due to existing disorders of the lungs. Pneumothoraces have been described in medical literature since the 15th century and may also be caused by certain medical procedures.

Primary, spontaneous causes

These causes affect people with healthy lungs, most oftentall, thin males younger than 40 years, especially if other family members have also had the condition. Small blisters (subpleural blebs) form on the surface of their lungs, although the reason why is not understood.

Secondary causes

These causes include a variety of chronic lung conditions that weaken or damage the lung tissue and allow air leakage into the pleural space.

  • COPD (emphysema): Inflammation of the lungs, often related to smoking, can weaken lung tissue.
  • Lung cancer: Abnormal tissue growth can damage lung tissue.
  • Asthma: Chronic inflammation can damage tissue.
  • Lung infections: Tuberculosis and severe forms of pneumonia, especially those associated with HIV infection, can damage lung tissue.
  • Cystic fibrosis: This genetic disease impairs the ability to clear mucus from the lungs and leads to frequent infections.
  • Smoking habit: Smoking cigarettes increases the risk for a collapsed lung by up to 20 times, even if you haven't developed COPD or lung cancer. The risk is proportional to the length of time and number of cigarettes smoked.
  • Other lung diseases: Interstitial lung disease (ILD) or connective tissue diseases, such as Marfan syndrome or Ehlers-Danlos syndrome, can weaken lung tissue.
  • Traumatic causes: Injuries to the chest, such as car accidents that cause broken ribs or stab wounds in the chest can cause air leaks.

Medical procedures

A collapsed lung is possible with these procedures:

  • Chest surgery: This also includes biopsies, which directly affect tissue
  • Thoracentesis: Drains fluid from the lungs
  • Bronchoscopy: Allows imaging of the airways
  • Mechanical ventilation: A machine that helps people breathe

Tension pneumothorax

This occurs in a minority of cases when damaged tissue can form a "one-way valve" that allows air into the chest but does not let any air exit. This causes the abnormal air collection to continuously get larger.The volume of abnormal air in the chest can become so large that the lungs are not able to take big enough breaths, the breathing tube (trachea) can be pushed to the side, and the heart is not able to pump enough blood to the body, causing blood pressure to drop. Without prompt medical attention, this can be a life-threatening condition, although deaths are rare.

Treatment Options and Prevention

Treatment depends on the volume of abnormal air in the pleural space and severity of symptoms.

Removing abnormal air from pleural space

Methods vary depending on how much air is present or the severity of your condition. These methods include:

  • Watching and waiting: If the pleural space contains a very small amount of abnormal air and you are comfortable, the condition may resolve on its own. Symptoms often improve within 24 hours, even if the collapsed lung has not completely resolved. Physicians can look at X-rays to ensure the air has been reabsorbed.
  • Oxygen: Breathing extra oxygen accelerates reabsorption of air from the pleural space.
  • Needle aspiration: A physician can insert a small needle through your chest wall to release excess air. This is a short procedure and the needle is removed immediately after the air is released.
  • Chest tube insertion: For larger collections of air, a physician can insert a small flexible tube into the chest wall and leave it in place for a few days. The tube is connected to a special valve or system of bottles so that air can exit but not enter the chest through the tube.
  • Surgery: If the collapsed lung does not improve after four to seven days of the treatments listed above, surgery may be recommended to close the air leak. This is usually minimally invasive, creating only a few small incisions and using a small camera.

Reducing the pain associated with breathing

Pain may be significant and may be remedied by:

  • NSAIDs: Nonsteroidal anti-inflammatory medications, such as ibuprofen (Advil, Motrin) or naproxen (Aleve) are effective at reducing this pain.
  • Lying on your affected side: This can make breathing more comfortable.
  • Getting plenty of rest: This helps your body heal.

Preventing a collapsed lung

About one-third of people who have a collapsed lung will have a repeat event, usually within three years of the first pneumothorax. This can be best prevented by:

  • Avoiding smoking
  • Addressing underlying conditions: You should control any underlying lung conditions, such as COPD.
  • Surgery: Your physician may recommend preventive surgery if you have had multiple episodes of collapsed lung or participate in activities, such as frequent flying or diving, that increase the risk of having a bad outcome if another pneumothorax occurs. Surgeons can "stick" the two linings together (pleurodesis) so the lung cannot collapse or they can remove a portion of damaged lung responsible for the air leak.

When to Seek Further Consultation

You should seek medical attention any time you have sudden and severe chest pain or difficulty breathing.

If you have sudden and severe chest pain and difficulty breathing

This can be a sign of a variety of medical conditions, including collapsed lung or heart attack, and should be evaluated promptly by a medical professional.

If you have an underlying lung condition and become short of breath

You can become ill very quickly from a collapsed lung or other complications of the lung disease and should contact your physician promptly if shortness of breath worsens.

If you have a history of collapsed lung and experience another episode of pain and shortness of breath

You should discuss long-term management options with your physician. If you have had a collapsed lung in the past, you're at increased risk of additional episodes.

Questions Your Doctor May Ask to Diagnose

  • Do you have a cough?
  • Any fever today or during the last week?
  • Are you sick enough to consider going to the emergency room right now?
  • How severe is your shortness-of-breath?
  • How long have you been having difficulty breathing?

Self-diagnose with our free if you answer yes on any of these questions.

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