27th May 2025

A 59-year-old gentleman presents to the Emergency Department with acute shortness of breath and pleuritic chest pain after a recent admission for a left-sided pneumothorax.

A 59-year-old gentleman presents to the Emergency Department with acute shortness of breath and pleuritic chest pain after a recent admission for a left-sided pneumothorax. He describes the symptoms as “exactly” the same as his last admission and is concerned about the development of a further pneumothorax. He has a known history of COPD, for which he is managed with Trimbow 2 puffs BD, theophylline 200mg BD and home long-term oxygen therapy 1L 16 hours a day. He manages all activities of daily living and walks his dog around the park daily. 

On examination, he has reduced air entry on the right with associated reduced chest expansion. A chest x-ray is completed. 

Investigations: 

Chest x-ray: R-sided pneumothorax 3cm. 

An intercostal drain is inserted, which improves his symptomatology.

What is the most appropriate definitive management strategy for his pneumothoraces? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.