A collapsed lung (pneumothorax) occurs when air leaks into the pleural space, the area between the lung and the chest wall. This accumulation of air builds pressure, pushing on the outer surface of the lung and causing it to partially or fully collapse. This condition is a medical emergency, requiring immediate medical intervention to restore normal lung expansion.
Recognizing the Signs of Pneumothorax
The most common sign of a pneumothorax is the sudden onset of sharp, stabbing chest pain. This discomfort often becomes worse when the person attempts to take a deep breath, cough, or sneeze. The chest pain is quickly accompanied by dyspnea, or severe shortness of breath.
A person experiencing a pneumothorax may also exhibit a rapid heart rate and fast, shallow breathing as the body attempts to compensate for the lack of oxygen. In more severe or rapidly progressing cases, a bluish discoloration of the skin, lips, or nails, known as cyanosis, can occur. While some cases are caused by external trauma, others occur spontaneously either in otherwise healthy people (primary) or in those with underlying lung disease (secondary).
Immediate Emergency Response
Recognizing these symptoms requires immediately calling emergency medical services. A pneumothorax can rapidly progress into a life-threatening condition called a tension pneumothorax, where air pressure continues to build and compresses the heart and major blood vessels. Self-treating or attempting to drive to a hospital is not advisable.
While waiting for medical help to arrive, the affected person should remain calm and still to minimize the body’s oxygen demands. Avoid strenuous movement or activity, which could increase the air leak. Sitting upright or in a semi-reclined position can help reduce pressure on the chest and make breathing easier until professionals can administer definitive care.
Clinical Treatment Options
Treatment for a collapsed lung depends on the size of the air pocket and the patient’s stability. For very small pneumothoraxes, particularly in stable patients without underlying lung disease, intervention may be limited to simple observation. Supplemental oxygen is often provided to speed up the reabsorption of the air by the body. The patient is monitored closely with serial chest X-rays to ensure the air pocket does not grow larger over time.
For moderate collapses, a procedure called needle aspiration is often performed to remove the excess air quickly. A doctor inserts a small, hollow needle between the ribs into the pleural space to draw the trapped air out using a syringe. This procedure is less invasive than other methods and is typically sufficient to relieve the pressure and allow the lung to re-expand.
When the pneumothorax is larger, or if needle aspiration fails to resolve the issue, chest tube insertion is the standard treatment. A tube is placed through the chest wall and connected to a one-way drainage system that continuously removes the air. This allows the negative pressure necessary for the lung to fully inflate and remain expanded, often requiring a hospital stay of several days until the air leak seals.
If the air leak persists despite chest tube drainage, or if a patient experiences a recurrence, surgical intervention becomes necessary. The most common surgical approach is Video-Assisted Thoracoscopic Surgery, or VATS, a minimally invasive procedure. During VATS, the surgeon identifies and seals the air-leaking area, often by removing small, damaged air sacs on the lung surface called blebs.
The surgeon may also perform pleurodesis, a procedure designed to prevent future collapses by adhering the lung surface to the inner chest wall. This is achieved by mechanically irritating the pleural lining or introducing a chemical agent, such as talc, into the space to create scar tissue. Pleurodesis is recommended for individuals whose occupations involve significant pressure changes, like pilots or deep-sea divers.
Recovery and Reducing Recurrence Risk
After successful treatment, the recovery period focuses on healing and preventing recurrence. Patients are typically restricted from air travel for at least one to two weeks following treatment, as cabin pressure changes can cause air remaining in the chest cavity to expand. Activities that involve significant changes in atmospheric pressure, such as scuba diving, must be avoided due to the high risk of recurrence. Follow-up appointments with repeat chest imaging are scheduled to confirm the lung remains fully inflated and to monitor for any long-term complications.
Physical activities, especially those involving heavy lifting or strenuous effort, are usually limited for several weeks to allow the body to fully heal. The most significant lifestyle change required to minimize recurrence risk is the absolute cessation of smoking.
Smoking is a major risk factor for primary spontaneous pneumothorax. Patients who smoke have a recurrence rate estimated to be up to twenty times higher than non-smokers. Quitting smoking is the most effective action a patient can take to protect their lung health and ensure the long-term success of the initial treatment.