ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax

Abstract

Primary spontaneous pneumothorax (PSP) affects young healthy people with a significant recurrence rate. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research.The European Respiratory Society's Scientific Committee established a multidisciplinary team of pulmonologists and surgeons to produce a comprehensive review of available scientific evidence.Smoking remains the main risk factor of PSP. Routine smoking cessation is advised. More prospective data are required to better define the PSP population and incidence of recurrence. In first episodes of PSP, treatment approach is driven by symptoms rather than PSP size. The role of bullae rupture as the cause of air leakage remains unclear, implying that any treatment of PSP recurrence includes pleurodesis. Talc poudrage pleurodesis by thoracoscopy is safe, provided calibrated talc is available. Video-assisted thoracic surgery is preferred to thoracotomy as a surgical approach.In first episodes of PSP, aspiration is required only in symptomatic patients. After a persistent or recurrent PSP, definitive treatment including pleurodesis is undertaken. Future randomised controlled trials comparing different strategies are required. @ERSpublications A European Task Force reviews scientific evidence and suggests future research for primary spontaneous pneumothorax

A case report of testicular choriocarcinoma complicated with pneumothorax

“…Spontaneous pneumothorax is classified into primary and secondary types: The primary type occurs in the absence of obvious lung disease, while the secondary type occurs in the presence of a known lung disease [9]. The most common cause of secondary spontaneous pneumothorax is a chronic pulmonary obstructive disease (COPD), which accounts for approximately 70% of cases.…”

Sudden Onset Dyspnea; Are We in Danger of Being Ageist with Our Diagnostic Sieve?

“…And finally, one study reviewing causes for reoccurrence of pneumothorax mentions 2 cases of spontaneous pneumothorax occurring after the age of 84years. 13 Finally both the British thoracic guidelines, 4 which are endorsed by the American Thoracic Society, 14 and the European Respiratory Society, 15 state PSP is rare post 55years old.…”

Surgery for primary spontaneous pneumothorax

“…The first point of discussion is the appropriate time to proceed with surgery in patients with PSP. There is an agreement that a final solution should be offered to the patient in case of recurrent ipsilateral PSP, simultaneous bilateral PSP, episode of PSP following a previous episode of contralateral PSP, first episode of tension pneumothorax, significant spontaneous hemopneumothorax at first episode, persistent air leak through the chest tube for more than 5-7 days or failure of the lung to re-expand despite adequate pleural space drainage in the first episode (3)(4)(5)(6). In addition, surgery at first episode of PSP should be offered in specific groups or individual patients with certain characteristics.…”

“…The main important variances are first, the resection or not of the lung apex in the absence of obvious blebs/bullae and second, the technique used to obtain a permanent pleurodesis. Parietal pleurectomy of various extent (apical or subtotal or of any other extent), pleural abrasion, chemical pleurodesis with talc or other agent (i.e., povidone-iodine, as described in the commented article) are the acceptable and commonly employed techniques to perform pleurodesis (3)(4)(5)(6)(7)(8)13,14). Parietal pleurectomy is considered the best technique to achieve pleurodesis, however it has the disadvantage of possible bleeding resulting in the formation of clotted hemothorax (7).…”