Spontaneous Pneumothorax: Follow up Treatment Outcome in a Tertiary Care Center of Eastern Nepal

Abstract

Background Spontaneous pneumothorax is not an uncommon medical emergency in pulmonary practice. Related data are not available in our setting. In emergency departments, clinical presentation is often confused with other cardiopulmonary problems. Follow up outcome is important for better patient care.
 Objective To study clinical profile and outcome after non surgical intervention in a tertiary care center.
 Method This was a prospective observational study carried out in Nobel Medical College, Biratnagar over last 3 years. We enrolled consecutive spontaneous pneumothorax patients over 15 years of age. Each data related to individual patients were collected in predefined proforma. To study follow up outcome of management, we used OPD attendance or if not possible took, at least two telephone numbers from the patients. All patients were followed for recurrences. Data was statistically analyzed using SPSS software.
 Result Over the last 3 years, we enrolled 65 spontaneous pneumothorax patients. Secondary spontaneous pneumothorax was more common (92.3%). Commonest presentations were acute pleuritic chest pain (92.3%), dyspnea (84.62%) and cough (92.3%). COPD (46.14%), PTB sequelae (15.38%), bronchiectasis (23.07%) and bullous lung disease (23.07%) were common risk factors. Tube thoracostomy (95.38%) with pleurodesis with iodopovidone (84.61%) led to lung expansion in 92.3% cases. During follow up, only 4.61% had recurrences of pneumothorax. There was one mortality.
 Conclusion Spontaneous pneumothorax is a common pulmonary emergency. Meticulous and careful assessment of the patients may help reach the diagnosis even in primary care setting. Tube thoracostomy followed by pleurodesis with iodo-povidone suffices in most circumstances leading lower future recurrences.

The burden of chronic respiratory diseases in adults in Nepal: A systematic review

“…Most of the studies were either of low (n ¼ 13) or moderate (n ¼ 12) quality, with two classed as high quality. Some studies reported on more than one condition, with the major diseases identified being: COPD (22 studies), 31,32,[34][35][36][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] asthma (8 studies), 20,32,36,37,49,[52][53][54] bronchiectasis (2 studies and as a co-morbidity in one), 30,40,52 restrictive lung diseases (3 studies), 49,51,52 and 'chronic bronchitis' (1 study). 29 Symptoms reported included chronic cough, phlegm or sputum production, breathlessness or shortness of breath, chest tightness, wheezing, dyspnoea and sore throat.…”

“…Reporting included presence of pulmonary arterial hypertension 30 and cor pulmonale. 29,30,35,51,52 Lung function was reported in seven studies, 29,32,33,38,47,48,51 and data presented across different spirometric measures, with one reporting proportions only of patients categorised as 'normal', 'obstruction' and 'restriction'. 51…”

“…Ten studies, including a total of 111,188 subjects reported on the prevalence of chronic respiratory diseases in a hospital setting (Table 2). 31,34,[42][43][44][45]49,51,53,54 The majority of studies reported on COPD among hospitalised patients, 31,34,[42][43][44][45] with other studies reporting on interstitial lung disease (ILD), 51 both COPD and asthma, 53,54 and outpatient spirometry referrals. 49 Overall estimates for the proportion of admissions due to COPD varied widely from 2.6% to 14% in studies including all hospital admissions and up to 17.3% in medical wards.…”

“…54 In a study where the majority of hospital admissions were attributed to injuries in young adults, respiratory complaints still accounted for 9.2% of total hospital admissions, with COPD or asthma accounting for 0.5% of total hospital admissions. 53 Ghimire et al 51 reported a prevalence of 0.4% for ILD among patients treated in hospital for pulmonary disorders. The majority of these ILD's were attributed to idiopathic pulmonary fibrosis (79.5%), and 68.1% of the patients were over the age of 60 years.…”

“…The majority of these ILD's were attributed to idiopathic pulmonary fibrosis (79.5%), and 68.1% of the patients were over the age of 60 years. 51 There was only one hospital-based study with spirometry for outpatients: the final diagnoses being bronchial asthma (24.2%), COPD (31.4%), and restrictive lung disease (8.1%) of those referred for testing. 49…”