Pneumothorax (Collapsed Lung)

Pneumothorax is a condition where air leaks into the pleural cavity (the space between the chest wall and the lungs). The air in the pleural cavity can further press against the lungs causing it to collapse – partially or fully. Pneumothorax is also referred to as collapsed lungs or punctured lungs. The condition can be a medical emergency and may exhibit symptoms such as chest pain on one side, cough, rapid breathing, tachycardia, fatigue, and others. The cause of pneumothorax is associated with injuries, medical conditions, and lifestyle factors.

• Primary Spontaneous Pneumothorax: Primary spontaneous pneumothorax occurs in individuals without any known lung disease. It results from the rupture of small air-filled sacs on the lung surface. 

• Secondary Spontaneous Pneumothorax: Secondary spontaneous pneumothorax is a result of existing lung conditions including, COPD, asthma, lung cancer, fibrosis, and more. 

• Traumatic Pneumothorax: As the name implies traumatic pneumothorax occurs as a result of chest injuries like gunshot, stab wounds, rib fractures that puncture the lung or chest wall, and more.

• Iatrogenic Pneumothorax: This type of pneumothorax results when the lung is punctured during medical procedures like a lung biopsy, central venous line insertion, etc.

• Tension Pneumothorax: Tension pneumothorax refers to a condition where the air enters the pleural space but cannot escape, leading to increased pressure on the lungs. Tension pneumothorax is referred to as a medical emergency.

• Chest Pain: Pneumothorax is known to cause sudden, sharp or stabbing pain in one side of the chest where the lung has partially or completely collapsed. The pain may worsen with breathing and coughing. 

• Shortness of Breath (Dyspnea): Shortness of breath is another very common sign of pneumothorax. It is due to the restricted ability of the collapsed lung to take air required by the body. 

• Fast Heart Rate: Increased or rapid heart rate is another symptom experienced by individuals with collapsed lungs. The heart beats faster to compensate for the reduced oxygen levels in the blood.

• Cyanosis: In severe conditions, due to lack of oxygen the skin, nails, and the lips may appear bluish. 

• Other symptoms include hacking cough, reduced breath sounds, fatigue, bubbling sensation in the chest, shallow breathing, and more.

• Chest Injury: Any injury or direct blow to the chest can cause lung collapse. Injuries that can lead to partial or complete lung collapse include car crashes, gunshot wounds, stab wounds, rib fractures, or medical procedures like lung biopsy, nerve block, etc. 

• Lifestyle Factors: Lifestyle factors including smoking, vaping, flying that involves drastic changes in air pressure, deep sea diving, and more can significantly increase the risk of pneumothorax. 

• Medical Condition: Medical conditions including COPD, asthma, pneumonia, cystic fibrosis, lung cancer, tuberculosis, and more can weaken the lung tissue, making it more susceptible to air leaks and rupture resulting in a pneumothorax. 

• Ruptured Air Blisters: Sometimes air blisters (small) may grow on the top of the lungs. These blisters may at times burst, leading to air leaks around the spaces surrounding the lungs. 

Risk Factors	Description
Genetics	Several types of pneumothorax are also associated with running in families.
Smoking	Smoking can lead to lung damage & inflammation resulting in the formation of air-filled sacs on the lung’s surface.
Lung Disease	Existing lung diseases including COPD, cystic fibrosis, pulmonary fibrosis, etc can increase the risk of developing pneumothorax.
Previous Pneumothorax	Anyone who’s had pneumothorax before is at increased risk of developing the condition again.
Certain Activities	Activities involving sudden air pressure changes including diving, flying, etc increase the risk of developing pneumothorax.

A pulmonologist helps diagnose pneumothorax through a physical examination and some imaging tests. During the physical examination, the pulmonologist may ask about the symptoms, and family history of lung diseases, and listen to the lungs with a stethoscope. Further, the doctor may recommend the following imaging tests to diagnose the condition:

• Chest X-ray: An X-ray helps identify the presence of air or fluid in the pleural space.
• CT Scan: CT scan helps visualise the condition better & also helps identify the lung condition that may have caused the pneumothorax. 
• Arterial Blood Gas Test (ABG): The ABG test is advised to measure the level of oxygen and carbon dioxide in the blood to diagnose the level of respiratory distress.

• Observation: The doctor might recommend just observing the condition if it is minor. The pulmonologist might suggest a series of chest X-rays to monitor the condition until the air is completely absorbed by the lung and it re-expands. 

• Needle Aspiration: Needle aspiration is a procedure where a needle is inserted between the ribs into the air-filled space to evacuate the air creating pressure on the lungs.

• Chest Tube Insertion: This procedure involves inserting a tube into the air-filled space attached with a valve device that removes air from the cavity until the lung completely re-expands.

• Pleurodesis: Pleurodesis is a procedure which involves creating adhesion between the lungs and the chest wall by inserting a tube, eliminating extra space and preventing further collapses.

Preventive Measures	Description
Avoid Smoking	Avoid smoking & second-hand smoke, quitting smoking significantly reduces the risk.
Manage Lung Conditions	Lung conditions like COPD, asthma, etc should be promptly managed as it can reduce the likelihood of developing this condition.
Avoid or Limit Certain Activities	Avoid or limit activities involving drastic air pressure changes like scuba diving, high-altitude travel, and more.
Prompt Medical Attention	Seek immediate medical attention, especially in cases related to trauma to avoid severe complications.