What is Pneumothorax?
Pneumothorax is a condition, whereby air gets collected in the plural cavity, the space between the chest wall and the lungs. This results in collapse of the lung on the affected part. The severity of this condition and the extent of the collapse depends on the amount of air that got deposited in the plural cavity.
This condition is can be classified into two main types:
The consequence and management of secondary pneumothorax is significantly greater as it happens to patients with pre-existing lung diseases.
The other causes for developing this condition are:
Traumatic pneumothorax that occurs following a deep chest trauma such as a gunshot, a stab wound or a fractured rib.Iatrogenic pneumothorax, which can happen following intravenous medical procedures like central line placement, percutaneous liver biopsy, lung biopsy or following a mechanical ventilation procedure.Catamenial pneumothorax that happens at the time of menstruation. Catamenial pneumothorax represent 3 to 6 percent of spontaneous pneumothorax in women, who are between 30 to 40 years and have a history of pelvic endometriosis in 20 to 40 percent of the cases. Catamenial pneumothorax typically happens in the right lung of the patients, within 72 hours from the onset of menstruation.
For diagnosis of lung collapse, the doctor listens to the patient’s lung with the help of a stethoscope, while asking the patient to breathe in and out deeply. If there is a pneumothorax then the doctor will have trouble hearing breath sounds while listening to the affected lung. The doctor may also order for an imaging test, to find a better view of the patient’s lung. Generally a chest X-ray or a CT scan is advised for diagnosing patients with collapsed lungs. The only treatment for pneumothorax is to restore normal functioning of the lungs, by eradicating external pressure on the lungs. Normally a small or mild pneumothorax doesn’t require any treatment. In this case the doctor generally monitors the patient’s condition and ensures that it gets better over time. Sometimes oxygen therapy is prescribed to provide extra oxygen to the lungs. Additionally patients suffering from lung collapse are advised to take plenty of rest.
If the pneumothorax is large, doctor can use a needle to remove air from the plural cavity.
The condition of pneumothorax is related to the lungs. It is caused when air goes inside the space between the lungs and the chest wall. This space is called a pleural space. The presence of air inside pleural space is considered abnormal. A serious level of this condition can also even cause death. This disease is found to be more common in men than women.
In medical terms, pneumothorax means collapsed lungs. The air inside the space between the lungs and chest puts pressure on the lung to make its way. This causes the lungs to collapse. Basically, a part of the lung collapses and not the whole lung. Because of this problem, the lungs do not expand as much as they should do while the person inhales. This issue can be mildly present or could be on a serious level. When it is mild, then it might get unnoticed by the person having it.
The symptoms of pneumothorax can start with chest pain which is most noticeable. This pain can be very sharp. Some people feel a kind of tightness in their chest. Other symptoms are:
- Increased heartbeats.
- Fast breathing.
- Dizziness or feeling of confusion.
- Fainting or even coma.
- Difficulty in inhaling- mainly pains which are sharp.
- Skin or lips turning blue.
There could be some other symptoms as well, because of the oxygen levels in the blood decrease. In some cases, it has been seen that there were no symptoms, but the problem existed. If any of the above-mentioned symptoms appear, seeking help from a doctor is advised. Especially in the case of breathing-related conditions, immediate action is very important before anything turns into a more serious issue.
Causes of Pneumothorax:
Pneumothorax is a lung disease. When the lungs or chest is affected by some reasons, this disease can appear. The causes for pneumothorax are fundamentally divided into three categories:
A primary spontaneous pneumothorax happens when the patient has no personal medical history of this disease or any lung disease. For such cases, determining the cause becomes even more difficult. There is a certain group of people who are at more risk of this kind of pneumothorax:
- People who take drugs for recreation like cannabis or tobacco.
- Men who are tall
- People in the age group of 15-34.
- If there is a family history of lung disease or specifically pneumothorax.
This type of pneumothorax is not very fatal if it is treated on time.
This is caused because of various kinds of lung disease and requires more medical assistance and care. This is also more serious than primary spontaneous pneumothorax. If not treated on time, it can also become the cause of a death. Family history also plays a role for this type of pneumothorax. Following are the types of lung diseases which can cause secondary spontaneous pneumothorax:
- COPD (Chronic Obstructive Pulmonary Disease): It is a term for a set of diseases which blocks the airflow and makes it very difficult for the person to breathe.
- Cystic fibrosis: It is mostly an inherited disease. Because of this disease, the fluids become sticky and thicken over time and then they are responsible for blockages.
- Asthma, especially if it is severe.
- Sarcoidosis: When lots of small inflammatory cells start growing in multiple parts of the body, that condition is called as sarcoidosis.
- Pulmonary fibrosis: This is caused when the tissues of the lungs get damaged for some reason and then those damaged tissues hinder the working of the lungs.
Not just the lung diseases, but certain tissue related diseases can be the reason as well, some of which are listed below:
- Marfan’s syndrome: It is also an inherited disease which affects the connective tissues of the body.
- Systemic sclerosis: When the connective tissues and skin hardens and tightens, it is called as systemic sclerosis.
- Polymyositis: It is basically inflammation of the muscles.
- Arthritis (rheumatic): It is also an inflammatory disorder, which leads to pain in joints in the body.
- Spondylitis: It is a kind of arthritis which affects larger joints, as well as the spine.
- Ehlers-Danlos syndrome: This syndrome also affects the connective tissues in the body, mainly the joints, skin or even the blood vessels.
It has also been seen that children also get this type of pneumothorax. The causes which can trigger this in children are as follows:
- Inhaling of an object which can harm the lungs or respiratory tract
- Congenital malformations
As the name suggests, this type of pneumothorax is caused by some injury or trauma. When the ribs are fractured due to some injury (like sports injury) or accident, the lungs can get punctured by the sharp ends of the broken bones. This is very harmful to the life of the person and can also cause rapid fall or even loss of blood pressure.
This type of pneumothorax can also happen even when the wounds of the injuries are not visible on the chest. This has been commonly observed in people who have gone through blast trauma in case of any kind of an explosion.
Sometimes, even some medical treatments can cause this type of pneumothorax. For example, when a catheter is put inside a vein in the chest or when some lung tissue samples are taken, it might increase the risk of getting a traumatic pneumothorax. Though when doctors perform these medical treatments, they keep caution and even after the treatment, they keep an eye on a person’s health to make sure there are no signs of this diseases.
How is it diagnosed?
Because the reasons for this disease to appear can be many, diagnosis becomes a bit complex. Usually, the diagnosis starts with a physical examination. They check for the sounds that are coming from the chest with the help of a stethoscope or simply by tapping. Many times, these sounds can depict if there is any abnormality. The doctors will also ask about the family history and medical history of the person. They would also need to know whether the person is a smoker or not. The doctors will also suggest going for an X-ray because it gives a picture of the lungs. This helps them in confirming their deduction after their physical examination. X-ray is done when the patient inhales and hold their breath for some moments.
While X-rays are good to make out the condition of the lungs, CT-scans are better in providing an improved imagery. This helps in checking the size of the pneumothorax and then the treatment can be given accordingly. Generally, CT scans are suggested when the situation is suspected to be serious by the doctors and an immediate treatment could be required. Another test which is useful for the doctors to investigate is ultrasound. The doctors might or might not suggest this. It depends on whether they want to get the tests done for blunt trauma or not.
Prevention from Pneumothorax:
Once a patient gets this disease, the chances of them getting it again are high. So even if they are healed once, they should take extra precautions to avoid getting it again. There are certain steps a person can take to avoid this problem, but following them will not guarantee that pneumothorax will not happen at all:
- People who do scuba diving needs to be a bit cautious too. They should take advice from their doctor to verify whether they can do it or not. This is because when they are scuba diving, they take the air from compressed air tanks. At that time, they experience varying levels of pressure of water as well as the air. The collective force of these varied pressures can damage the lungs which could result in pneumothorax.
- If there is any history of this disease, or any other chest or lung disease, then repeated visits to the doctor for a regular check-up is advised. It is important to keep an eye on the health of the lungs, especially when the person is aware that there were issues with them in the past.
When the person is recovering from pneumothorax, they must be very careful. The doctors advise should be dutifully followed. They should also:
- Switch back to their normal routine slowly, not suddenly.
- Report to the doctor if any issues like a cough containing blood or fever are present.
- Avoid lifting heavy objects.
- Avoid using vacuum cleaners or even lawn mowing.
- Confirm their physical regime from the doctor. They might need to avoid heavy exercises and extreme physical workouts.
- Confirm with the doctor if they can travel in flight or go to higher altitudes.
This will help them in preventing the collapse again in case they had it before.
Treatment of Pneumothorax:
Most of the times, the treatment of pneumothorax cannot be done by the patient themselves. The size of the problem determines how much medical attention is required. Generally, the doctors put a tube inside the body of the patient. The tube is put either between the ribs, or it is placed under the collarbone. That tube is used to relieve the gas which causes pneumothorax. When this gas is relieved, it helps the lungs in inflating again.
Other than this, doctors can also prescribe some pain relievers which help patients in relieving the pain. Drugs might also be required to remove the toxins and avoid infection.
If the condition is severe, and the person is finding it hard to breathe, then oxygen support might also be required. Sometimes, doctors need to perform surgery but that mostly happens with patients who keep getting the pneumothorax.
If the condition is very mild, then it might just heal by itself, but that is for the doctor to decide the severity of the disease. Initially, doctors might ask the patient to wait and see if it heals by itself and keep checking the progress. If it does not heal, then other treatments are given.
The biggest complication for patients with pneumothorax is that once they get it, they can get it again. The time within which they can expect it again is between a year and two. In fact, the air leaks might keep on happening slowly in case the opening of the lungs is not properly closed. In such cases, the doctor should be referred to so that they can advise a long-lasting solution.
Also, if the person is already suffering from any type of pneumothorax (primary, secondary or traumatic), there are chances that it can get converted into the tension pneumothorax. This happens when the air leaks inside the pleural space. When the patient inhales, that air which is leaking gets trapped and cannot find a way to go out. This increases the air pressure in that pleural space and if immediate treatment is not provided, then it can lead to the life-threatening situation.
It is often believed that the only reason why lungs collapse is smoking. Though smoking plays a very major role in deteriorating the health of the lungs; but pneumothorax can also be caused because of other reasons specified. And once it happens, the patient must stay away from smoking to avoid getting this problem once more. Smoking increases the chances of getting the pneumothorax. In fact, the probability of getting this disease is 22 times more in people who smoke than those who don’t. Still, it does not mean that quitting smoking will guarantee that pneumothorax won’t happen. It greatly reduces the chances though, which is why smoking should be avoided.
What is Pneumothorax?
This condition is can be classified into two main types:
The other causes for developing this condition are: