By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

SPONTANEOUS COLLAPSED LUNG COMMON IN TALL, THIN, YOUNG MEN

Question: Recently my son had a collapsed lung. He was away at college when this happened. He said it just happened while he was studying. He is OK now, but I would like to know more about this. Will it happen again? What caused it? No one in our family has ever had this happen.

Answer: Pneumothorax is the medical term for a collapsed lung. This word is a combination of “pneumo” meaning air and “thorax” referring to the chest cavity. It is, therefore, air trapped within the chest cavity -- but not within the lungs themselves. The air, or gas, can get into this space if there is a hole in the lung.

There are several different types of pneumothorax. One basic division is between traumatic and spontaneous. Traumatic pneumothorax is caused by injury. Spontaneous pneumothorax, which is what I will be focusing on in today’s column, develops without any traumatic injury to the chest or lung.

Most spontaneous pneumothorax cases in your son’s age group are classified as primary. This means that there are no underlying lung diseases. This type of pneumothorax is seen most often in tall, thin men between the ages of 20 and 40. Frequently, it’s caused by the rupture of a small cyst-like structure in the lung.
And, while they do not have known lung disease, over 91 percent of people with primary spontaneous pneumothorax are smokers. This type of pneumothorax occurs in men six times more frequently than in women.

As with your son, spontaneous pneumothorax usually occurs at rest, and sometimes, even during sleep. There is an acute onset of shortness of breath as well as sharp chest pain that often radiates to the shoulder on the affected side. When the patient arrives in the hospital emergency department, he or she is holding the chest, slightly short of breath, pale and sweaty. The sufferer has rapid pulse and respirations. An astute physician will make a presumptive diagnosis by listening to the chest, but a chest C-T scan is the most reliable diagnostic test. A plain chest X-ray can be used to make the diagnosis, but it’s slightly less reliable.

Once the diagnosis is made, the patient is given oxygen and admitted to the hospital, at least for observation. Sometimes a needle is placed into the airspace and the air is drawn out. If the amount of air is large, the patient may need a chest tube. It takes about 10 days for a pneumothorax to heal completely. Most people are out of the hospital in two or three days.

There is a recurrence rate in the first six months to three years of about 25 percent. Smokers should take a pneumothorax incident as their body’s early warning signal to stop smoking immediately. Also, air travel or travel to remote areas should be restricted until the pneumothorax is completely healed.

Though probably not applicable to your son’s case, there is another type of spontaneous pneumothorax called secondary. This is more common in older people. It is seen most often as a complication of chronic obstructive pulmonary disease (COPD). Other lung diseases that can be associated with secondary spontaneous pneumothorax include: tuberculosis, pneumonia, asthma, cystic fibrosis, whooping cough, interstitial lung disease, and lung cancer.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.