title: Spontaneous pneumothorax: time to rethink management?
abstract: There are substantial differences in international guidelines for the management of pneumothorax and much geographical variation in clinical practice. These discrepancies have, in part, been driven by a paucity of high-quality evidence. Advances in diagnostic techniques have increasingly allowed the identification of lung abnormalities in patients previously labelled as having primary spontaneous pneumothorax, a group in whom recommended management differs from those with clinically apparent lung disease. Pathophysiological mechanisms underlying pneumothorax are now better understood and this may have implications for clinical management. Risk stratification of patients at baseline could help to identify subgroups at higher risk of recurrent pneumothorax who would benefit from early intervention to prevent recurrence. Further research into the roles of conservative management, Heimlich valves, digital air-leak monitoring, and pleurodesis at first presentation might lead to an increase in their use in the future.
authors.affiliation: Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Bintcliffe
authors.affiliation: Oxford Centre for Respiratory Medicine and Oxford NIHR Biomedical Research Centre, Churchill Hospital, Oxford, UK.
authors.forename: Rob J
authors.initials: RJ
authors.lastname: Hallifax
authors.affiliation: Department of Radiology, North Bristol NHS Trust, Bristol, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Edey
authors.affiliation: Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: David
authors.initials: D
authors.lastname: Feller-Kopman
authors.affiliation: Centre for Asthma, Allergy and Respiratory Research, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
authors.forename: Y C Gary
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Service de Pneumologie, Centre Hospitalier Universitaire de Nice, France.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Marquette
authors.affiliation: Centre Valaisan de Pneumologie, Montana, Switzerland.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Tschopp
authors.affiliation: University Hospitals Bristol, Bristol, UK.
authors.forename: Douglas
authors.initials: D
authors.lastname: West
authors.affiliation: Oxford Centre for Respiratory Medicine and Oxford NIHR Biomedical Research Centre, Churchill Hospital, Oxford, UK.
authors.forename: Najib M
authors.initials: NM
authors.lastname: Rahman
authors.affiliation: Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK. Electronic address: nick.maskell@bristol.ac.uk.
authors.forename: Nick A
authors.initials: NA
authors.lastname: Maskell
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000553:Ambulatory Care / Q000379:methods; D017558:Elective Surgical Procedures; D006801:Humans; D008875:Middle Aged; D011030:Pneumothorax / Q000145:classification / Q000209:etiology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012008:Recurrence; D018570:Risk Assessment; D055502:Secondary Prevention; D014057:Tomography, X-Ray Computed; D055815:Young Adult