Treatment for a collapsed lung (pneumothorax) depends on how much of the lung has deflated and how severe your symptoms are. A small collapse in someone breathing comfortably may only need monitoring, while a large or life-threatening one requires immediate intervention to let the trapped air escape. The main options range from simple observation to needle drainage, chest tubes, and surgery.
How Doctors Decide What You Need
The first step is a chest X-ray to confirm the diagnosis and measure how much air has leaked into the space around your lung. Doctors gauge the size of the collapse by measuring the gap between the lung and the chest wall. If that gap is less than about 2 centimeters, the collapse is generally classified as small. Anything larger than that is considered a large pneumothorax and typically requires active treatment.
Your symptoms matter just as much as the size. If you’re breathing easily and your oxygen levels are stable, a small collapse can sometimes resolve on its own. But if you’re short of breath, in significant pain, or showing signs of strain on your heart and circulation, doctors will intervene regardless of the size on the X-ray.
Observation for Small Collapses
When the collapse is small and you feel relatively well, the treatment may simply be observation. You’ll stay in the hospital for several hours (sometimes overnight) so staff can monitor your breathing and repeat imaging to make sure the air pocket isn’t growing. The body gradually reabsorbs the trapped air on its own, though this can take a few weeks. Supplemental oxygen through a nasal cannula can speed up reabsorption. You’ll typically be sent home with instructions to return if your breathing worsens.
Needle Aspiration
For a larger collapse in someone who is otherwise stable, doctors often try needle aspiration first. A thin needle (typically 20 or 22 gauge, roughly the size used for a blood draw) is inserted through the chest wall into the air pocket, and the trapped air is pulled out with a syringe. The procedure is quick and can be done at the bedside with local anesthesia.
About 53% of patients have their lung fully re-expand on the first attempt. If the first try doesn’t work, a second or third aspiration can be attempted, and the overall success rate climbs to roughly 76%. When aspiration fails, the next step is usually a chest tube.
Chest Tube Insertion
A chest tube is the standard treatment when needle aspiration doesn’t work, when the collapse is large, or when air keeps leaking. Doctors numb the area on your side between the ribs, make a small incision, and slide a flexible tube into the pleural space (the gap between your lung and chest wall). The tube connects to a drainage system that uses suction or a one-way valve to pull air out continuously. For a pneumothorax, the tubes used are typically in the 24 to 28 French range, which is roughly the diameter of a pencil.
Having a chest tube in place isn’t comfortable. You’ll feel pressure at the insertion site, and deep breaths or coughing can be painful. Pain medication helps, but most people describe the experience as unpleasant. The tube stays in until imaging confirms the lung has re-expanded and there’s no ongoing air leak. For many patients, that’s two to five days, though it varies.
When it’s time for removal, you’ll be asked to breathe out fully or bear down (a Valsalva maneuver) while the tube is pulled. This increases pressure inside your chest and helps prevent air from sneaking back in during removal. A follow-up X-ray confirms the lung stays inflated.
Emergency Needle Decompression
A tension pneumothorax is the most dangerous form. Trapped air builds up so much pressure that it compresses the heart and the other lung, causing blood pressure to plummet. This is a true emergency. Paramedics or emergency physicians insert a large-bore needle directly through the chest wall, usually in the second intercostal space just below the collarbone on the midclavicular line, to release the pressure immediately. This buys time until a chest tube can be placed. It’s a dramatic intervention, but it can be lifesaving within minutes.
Surgery for Persistent or Recurring Collapses
Surgery becomes the recommendation in two main scenarios: when an air leak persists for more than about four days despite a chest tube, or when someone has had more than one collapsed lung on the same side. The most common approach is video-assisted thoracoscopic surgery (VATS), a minimally invasive procedure done through a few small incisions using a camera and instruments.
During VATS, the surgeon removes any blebs or bullae, which are small, weak-walled air blisters on the lung surface that tend to rupture and cause the collapse in the first place. This step alone (bullectomy) has a recurrence rate of about 15%. To bring that number down, surgeons also roughen or strip part of the pleural lining to encourage the lung to scar and adhere to the chest wall, a process called pleurodesis or pleurectomy. When bullectomy is combined with both pleurectomy and mechanical pleurodesis, some studies report a recurrence rate as low as 0%.
Adding chemical pleurodesis, where an irritating substance is applied to the pleural space, has been associated with a 63% lower risk of the pneumothorax coming back compared to surgery without it. Recovery from VATS typically involves a few days in the hospital and a few weeks of limited activity at home. Most people return to normal daily life within a month, though strenuous exercise takes longer.
Recurrence Risk Without Surgery
One of the most important things to understand about a collapsed lung is that it tends to happen again. After a first episode, the recurrence rate ranges widely depending on the study, but the British Thoracic Society puts it at roughly 54% within the first four years. Secondary spontaneous pneumothorax, meaning one caused by an underlying lung condition like COPD, carries a similarly high recurrence range of 23% to 47%. This is why surgery is strongly considered after a second episode rather than continuing to manage each collapse individually.
Activity Restrictions After Treatment
After your lung has re-expanded and treatment is complete, you’ll need to hold off on certain activities. Air travel is generally safe once a chest X-ray confirms full resolution, but you should wait at least seven days after that X-ray before flying. The lower cabin pressure at altitude can cause any residual trapped air to expand, and flying too soon risks re-collapse.
Scuba diving is a more permanent concern. Most pulmonologists advise against ever diving again after a spontaneous pneumothorax, because the pressure changes underwater create a very high risk of recurrence. This applies even after surgical repair, unless the surgeon and a diving medicine specialist specifically clear you. Other restrictions during recovery include avoiding heavy lifting, intense exercise, and playing wind instruments for several weeks, though your doctor will give you a timeline based on your specific situation.