Respiratory - Pneumothorax Aftercare

This leaflet gives you information about what a pneumothorax is, what treatment options you may be offered, what you must avoid post pneumothorax and contact details of our specialist respiratory teams.

What is a Pneumothorax?

A pneumothorax occurs when air leaks into the space between your lung and chest wall. This air pushes on the outside of lung and make it collapse; hence it is commonly referred to as a “collapsed lung”

A pneumothorax can cause complete lung collapse or a collapse of portion of lung only.

What causes a Pneumothorax?

There are several causes of pneumothorax.

Pneumothorax can happen unexpectedly without any obvious cause in young and healthy adults. When this occurs, it is called a spontaneous pneumothorax.

Smoking is the most significant risk factor for pneumothorax but it can commonly also be seen in patients with a family history.

It also commonly occurs in patients with chronic lung disease such as COPD (chronic obstructive pulmonary disease), interstitial lung disease (ILD) and other lung problems as well.

Sometimes a pneumothorax can happen after injury to the chest or medical procedures on the chest or lung.

What symptoms might I get?

The most common symptom you may experience is sudden chest pain (sharp and stabbing) on one side of your chest. Some people may feel pain at the shoulder or shoulder blade and pain is usually worse on breathing.

You may also experience shortness of breath or dry cough.

Some patients may have minimal symptoms or similar symptoms to their previous pneumothorax (if recurrent).

What treatment options may be offered?

The treatment for your pneumothorax depends on how large it is, how unwell it makes you and your personal treatment preferences.

You may not need any treatment if you have a small pneumothorax, as the lung will slowly re-expand and gradually reabsorb the air that has leaked out. You may be called back for a repeat chest X-ray and follow up in our specialist clinic in either Salford Royal, Royal Oldham or Fairfield General Hospitals. This healing process may take a few weeks.

If you do need treatment, then you may be offered one of the following to help re-expand your lung (not all options are suitable for everyone).

All procedures are performed under local anaesthetic (the area will be numbed, and you will be awake during the procedure).

Pleural (Needle) Aspiration

This is a relatively simple procedure where a small plastic tube (catheter) is inserted through the chest wall, air is drawn off and then the catheter is removed. You should be able to be discharged on the same day after this procedure.

Chest drain

In this procedure a drainage tube (similar size to a regular drinking straw, occasionally larger) is inserted between the ribs. This method is typically used when patients are more unwell or there is evidence that the air is still actively leaking air.

The tube is held in place with a stitch and dressing and connected to a fluid filled bottle (chest drainage bottle) which allows the air to bubble out without going back into your chest.

This tube usually stays in place for at least 24 to 48 hours, and you will need to stay in hospital during this period.

Very occasionally, we may apply ‘suction’ to the drain to draw air out. If this still does not heal the lung, we may ask the chest surgeons to consider doing an operation to try and find the damage to the lung and repair it.

Ambulatory draining device

Some patients can have a device in place to drain the remaining air at home over weeks.

The choice of device, technique, after care and follow-up will be based on the underlying lung problem and local availability.

Some of the commonly available devices are:

1.    Rocket pleural vent (picture 1) – A small plastic tube (catheter) will be inserted, and the device is secured to the front of your chest. The device will have holes on the sides to let the air out but not back into the chest.

2.    Furhman device with Heimlich valve (picture 2) - This is an alternative device which can be connected to a chest drain. A one-way valve is attached, which allows air to escape from the chest, but not back in.

3.    Cook drain kit with Heimlich valve (picture 3) - This has similar mechanism as Furhman device used in certain centres.

Image of Furhman drain courtesy of ResearchGate

Aftercare – what can and can’t I do?

Avoid flying for at least 7 days after complete resolution has been confirmed by chest x-ray. This is a minumum and we recommend you wait at least a few weeks, especially if you have other diagnosed lung conditions such as COPD. If you are unsure, please speak to your respiratory specialist in clinic on follow-up.

You should never scuba dive/dive with any pressurised gas cylinders unless you have had surgery to repair the lung. If in doubt, please check with your respiratory specialist/consultant.

Smoking greatly increases your risk of a pneumothorax happening again; it is strongly recommended that you quit smoking. You can seek smoking cessation support through your local pharmacy or GP, or we can refer to your local community team if you would prefer. If you are an inpatient, we can refer you to our inpatient smoking cessation team.

Once your symptoms have eased, you should be able to resume normal activities and working.

We would advise avoiding contact sports or heavy lifting until complete resolution of the pneumothorax has been confirmed on a chest x-ray and symptoms have eased. If in doubt, please contact your doctor.

When should I seek medical advice?

• 1 in 3 people will have a pneumothorax again. Symptoms are commonly the same as you experienced before
• If you notice any development of new symptoms such as worsening breathlessness or sudden onset chest pain - you should attend A&E straight away

Useful Contacts

During working hours, please contact the relevant team at your local hospital:

Salford Royal Hospital - 0161 206 3187

Royal Oldham Hospital - 0161 778 5339

Fairfield General Hospital - 0161 778 3016

Outside of working hours, please attend your nearest Accident and Emergency department.

Want to read more about Pneumothorax?

https://www.asthmaandlung.org.uk/conditions/pneumothorax- collapsed-lung