Risk of recurrence of spontaneous pneumothorax

There is a significant rate of recurrence of both primary and secondary pneumothoraces

• the recurrence rate for primary pneumothorax is more than 20% after the first episode and even greater after the second episode and tends to be more likely in women, tall men and smokers (1)

Management of recurrent spontaneous pneumothorax varies and the optimum procedure for preventing such recurrences remains controversial due to the lack of data comparing various recurrence prevention methods (2). Available treatment options include:

• medical treatment
  • medical chemical plerurodesis
    • should only be used if a patient is either unwilling or unable to undergo surgery
      
      
• surgical treatment
  • thoracoscopy with talc poudrage
  • video-assisted thoracoscopic surgery (VATS) with (partial) pleurectomy or talc poudrage
  • a thoracotomy with partial or complete pleurectomy
    • BTS suggests that open thoracotomy and pleurectomy remain the procedure with the lowest recurrence rate (approximately 1%) for difficult or recurrent pneumothoraces
  • BTS recommends that prevention of recurrent pneumothoraces should be undertaken surgically using either an open or VATS approach

Reference:

• (1) Currie GP et al. Pneumothorax: an update. Postgrad Med J. 2007; 83(981): 461-465
• (2) Tschopp JM et al. Management of spontaneous pneumothorax: state of the art. Eur Respir J. 2006;28(3):637-50