What is the prognosis of 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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The prognosis varies among the pneumothorax classifications.

Primary, secondary, and recurring spontaneous pneumothorax

Complete resolution of an uncomplicated pneumothorax takes approximately 10 days. PSP is typically benign and often resolves without medical attention. Many affected individuals do not seek medical attention for days after symptoms develop. This trend is important, because the incidence of reexpansion pulmonary edema increases in patients whose chest tubes have been placed 3 or more days after the pneumothorax occurred.

Recurrences usually strike within the first 6 months to 3 years. The 5-year recurrence rate is 28-32% for PSP and 43% for SSP.

Recurrences are more common among patients who smoke, patients with COPD and patients with AIDS. Predictors of recurrence include pulmonary fibrosis, younger age, and increased height-to-weight ratio. In a retrospective study of 182 consecutive patients with a newly diagnosed first episode of pneumothorax, a higher rate of recurrence was noted in taller patients, thin patients, and patients with SSP.

Patients who underwent bedside chest tube pleurodesis had cumulative rates of recurrence of 13% at 6 months, 16% at 1 year, and 27% at 3 years compared with 26%, 33%, and 50%, respectively. The agent used (tetracycline or gentamicin) did not have any significant impact on the recurrence rate.

Bullous lesions found on CT or at thoracoscopy and the presence of ELCs in PSP are also not predictive of recurrence. However, contralateral blebs were seen by CT scanning in higher frequency in the patients with contralateral recurrence (33 patients; 14%) than those without a contralateral recurrence in a retrospective study of 231 patients with PSP. Primary bilateral spontaneous pneumothorax (PBSP) was significantly more common in patients with lower body mass index (BMI) and among smokers. [32] In this series, all patients with contralateral recurrence were treated surgically.

Although some authors view PSP as more of a nuisance than a major health threat, deaths have been reported. SSPs are more often life threatening, depending on the severity of the underlying disease and the size of the pneumothorax (1-17% mortality). In particular, compared with similar patients without pneumothorax, age-matched patients with COPD have a 3.5-fold increase in relative mortality when a spontaneous pneumothorax occurs, and their risk of recurrence rises with each occurrence. One study indicated that 5% of patients with COPD died before a chest tube was placed.

Patients with AIDS also have a high inpatient mortality rate of 25% and a median survival of 3 months after the pneumothorax. These data were derived from an era before highly active antiretroviral therapy (HAART) was available.

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