Treatment outcomes of pneumothorax with chronic obstructive pulmonary disease.
BACKGROUND
Coexisting pulmonary fibrosis and emphysema in the same individual has received increased attention. We retrospectively investigated treatment outcomes of secondary spontaneous pneumothorax in chronic obstructive pulmonary disease patients with both pulmonary fibrosis and emphysema.


METHODS
Among 362 consecutive secondary spontaneous pneumothorax patients treated at our hospital from 2003 to 2012, 58 with emphysema-dominant chronic obstructive pulmonary disease (all elderly men with a smoking history) were enrolled and divided into 2 groups based on computed tomography images: emphysema alone (n = 51) and coexisting emphysema and pulmonary fibrosis (n = 7). The clinical characteristics and mortality were compared between the 2 groups.


RESULTS
There was no significant difference in the recurrence rate after nonsurgical treatment. No patient died of pneumothorax-related complications, but one of 2 with pulmonary fibrosis who underwent surgery died of a postoperative respiratory complication. The mortality rate from respiratory failure during follow-up was significantly higher in the group with pulmonary fibrosis (6/7) than in the group without pulmonary fibrosis (11/51, p = 0.002). The median survival was 0.8 years in the group with pulmonary fibrosis vs. and 5.4 years in the group without pulmonary fibrosis.


CONCLUSIONS
The coexistence of pulmonary fibrosis and emphysema on computed tomography images may represent a predictor of respiratory mortality in elderly chronic obstructive pulmonary disease patients with secondary spontaneous pneumothorax. Because of the potential risk of respiratory failure, we recommend nonsurgical treatment for secondary spontaneous pneumothorax in chronic obstructive pulmonary disease patients with these radiological features.
Department of Thoracic Surgery, Akita Red Cross Hospital, Akita, Japan.
Hideki
H
Ota
Hideki
H
Kawai
Tsubasa
T
Matsuo
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D011656:Pulmonary Emphysema / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D011658:Pulmonary Fibrosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D012008:Recurrence; D012131:Respiratory Insufficiency / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Pulmonary bullae causing pneumothorax; chronic obstructive; pulmonary disease; pulmonary emphysema; pulmonary fibrosis; treatment outcome