Pneumothorax Caused by Aggressive Use of an Incentive Spirometer in a Patient With Emphysema

Abstract

A 68-year-old man presented to the emergency department with a small pneumothorax following aggressive use of an incentive spirometer. The patient had a baseline chest radiograph consistent with emphysema. He was initially treated with oxygen in the emergency department, with resolution of his symptoms. The pneumothorax resolved spontaneously over a period of 3 days. The development of the pneumothorax was likely due to the patient's repeated forceful inspiratory maneuvers in the setting of emphysema and lung hyperinflation. Inspiratory resistive breathing can cause large negative swings in intrathoracic pressure, which may result in mechanical stress of lung tissue. This is the first report of a secondary pneumothorax associated with use of an incentive spirometer. Patients with bullous emphysema should be counseled to avoid frequent high intensity maneuvers with an incentive spirometer if the potential benefits of the procedure are marginal.

Incentive spirometry to prevent pulmonary complications after chest trauma: a retrospective observational study

“…30 A case report described the occurrence of secondary pneumothorax after IS in a postoperative patient with chronic obstructive pulmonary disease. 11 However, IS is generally considered to be safe. We did not find any study that reported the adverse effects of IS in trauma patients.…”

“…The secondary outcome measures were length of hospital stay, duration of oxygenation therapy, and adverse events of IS (e.g., exacerbation of pneumothorax or worsening of pain). 11 The above variables were determined from the patients' medical records.…”

INTERACTIVE CASE REPORT: A Rare Complication of Spirometry: Pneumothorax

“…Additionally, iatrogenic pneumothorax may occur due to non-invasive diagnostic methods, such as spirometry. Breathing maneuvers with a spirometer decreases pleural pressure, increases transpulmonary pressure, and produces large negative swings in intrathoracic pressures, which is similar to the Müller maneuver (19,20). A possible complication of an abrupt increase in transpulmonary pressure is pneumothorax secondary to the barotrauma (7).…”

Emphysema extent on computed tomography is a highly specific index in diagnosing persistent airflow limitation: a real-world study in China

“…Patients with dysaudia or other hearing disorders tend to get unsatisfactory spirometry results 3,4. Furthermore, patients with severe emphysema are not recommended to do spirometry for the high risk of pneumothorax 5. In addition, spirometry could detect and monitor the fluctuation of airflow limitation such as COPD exacerbation sensitively 6,7.…”