Which patient groups are at highest risk for spontaneous pneumothorax?

Updated: Apr 28, 2020
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Answer

The epidemiologic data vary among the pneumothorax classifications.

Primary, secondary, and recurring spontaneous pneumothorax

It is likely that the incidence for spontaneous pneumothorax is underestimated. Up to 10% of patients may be asymptomatic, and others with mild symptoms may not present to a medical provider.

PSPs occur in people aged 20-30 years, with a peak incidence is in the early 20s. PSP is rarely observed in people older than 40 years. The age-adjusted incidence of PSP is 7.4-18 cases per 100,000 persons per year for men and 1.2-6 cases per 100,000 persons per year for women. [29] The male-to-female ratio of age-adjusted rates is 6.2:1.

SSPs occur more frequently in patients aged 60-65 years. The age-adjusted incidence of SSP is 6.3 cases per 100,000 persons per year for men and 2.0 cases per 100,000 persons per year for women. The male-to-female ratio of age-adjusted rates is 3.2:1. Chronic obstructive pulmonary disease (COPD) is a common cause of secondary spontaneous pneumothorax that carries an incidence of 26 cases per 100,000 persons. [30]

Smoking increases the risk of a first spontaneous pneumothorax by more than 20-fold in men and by nearly 10-fold in women compared with risks in nonsmokers. [31] Increased risk of pneumothorax and recurrence appears to rise proportionally with number of cigarettes smoked.

In men, the risk of spontaneous pneumothorax is 102 times higher in heavy smokers than in nonsmokers. Spontaneous pneumothorax most frequently occurs in tall, thin men aged 20-40 years.


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