Who's (still) afraid of talc?

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

“…A European multicentre randomised controlled study compared treatment of PSP with a chest tube alone with simple talc poudrage by medical thoracoscopy and found a higher recurrence rate in the chest tube group than in the talc poudrage group (27% versus 5%, respectively), resulting in a reduced total healthcare cost in the poudrage group [115]. Talc poudrage under thoracoscopy is a safe, cheap and very efficient agent for achieving pleurodesis provided graded talc is chosen for pleurodesis [119,120,141,142]. The recurrence rate seen after talc poudrage is comparable to that seen after mechanical pleurodesis [143][144][145].…”

Pneumothorax

“…This can be achieved my mechanical abrasion, partial resection, or thoracoscopic instillation of an abrasive agent, usually talc. There is undisputable evidence that the use of size-calibrated talc is absolutely safe, in short- as well as long-term follow-up studies [71,72,73,74]: it does not cause cancer, pulmonary fibrosis, impaired pulmonary function or impaired subsequent thoracic surgery, and it is by far the cheapest agent. Thoracoscopic recurrence prevention techniques, be they ‘medical’ or ‘surgical’, usually show recurrence rates between 0 and 10%.…”

Surgery for primary spontaneous pneumothorax

“…The reported in the past sporadic cases of pneumonitis and ARDS after talc poudrage of the pleural cavity were not observed in the relatively recent large multicentre European study of 418 patients who underwent thoracoscopic talc pleurodesis for the prevention of PSP recurrence (16). Talc is definitely considered to be a safe agent to perform pleurodesis, even in benign pleural diseases such as PSP (16,17).…”