21st February 2025

Management of pneumothorax

Traumatic pneumothorax should be referred to thoracic surgeons and monitored closely, as there is a risk of developing a tension pneumothorax.

Spontaneous pneumothorax management depends on several factors, including:

• Size: rim of air between lung and chest wall at the level of the hilum (small <2 cm, large >2 cm) (Figure 1)
• Symptom severity
• Pneumothorax type (primary spontaneous/secondary spontaneous)

As per British Thoracic Society (BTS) guidelines:

Table 10 Management of pneumothorax

Bilateral pneumothorax is potentially life-threatening and should proceed straight to bilateral chest drain insertion.

Follow up

Smoking cessation is important to reduce risk of recurrence.

In some cases, surgical intervention via VATS or thoracotomy may be advised to prevent recurrence. Chemical pleurodesis can also be considered.

Flying should be avoided until full resolution of the pneumothorax. Patients should be advised to avoid underwater diving permanently following a pneumothorax unless they have definitive surgical management.