Pneumothorax is a condition when air collects in the cavity pleura, which is the space between the lungs and the chest wall. The air can enter due to an injury to the chest wall or a tear in the lung tissue. As a result, the lungs become deflated (collapsed) and cannot expand.
Based on the cause, pneumothorax is divided into two, namely traumatic pneumothorax and nontraumatic pneumothorax. Traumatic pneumothorax can result from injury to the lungs or chest wall, whereas nontraumatic pneumothorax can occur with or without lung disease.
If viewed from the severity, pneumothorax can be classified into:
- Simple pneumothorax
On simple pneumothorax, only part of the lung collapses, but it can cause a decrease in blood oxygen levels and shortness of breath. Simple pneumothorax not an emergency, but still needs to be monitored.
- Tension pneumothorax
On tension pneumothorax, all parts of the lung collapse, causing a decrease in the function of the heart and other organs. Tension pneumothorax can cause death if not treated immediately.
Causes of Pneumothorax
Pneumothorax can occur suddenly with no known cause or as a result of any of the following conditions:
- Lung diseases that cause tissue damage, such as chronic obstructive pulmonary disease (COPD), lung infections, and cystic fibrosis
- Injuries to the chest, for example from gunshot wounds, stab wounds, impacts, broken ribs, or medical procedures, such as biopsies and CPR
- Rupture of air-filled sacs (blebs) outside the lungs due to emphysema or COPD
- Imbalance of air pressure in the chest due to the use of a breathing apparatus or ventilator
Pneumothorax Risk Factors
Pneumothorax basically can be experienced by anyone. However, people with the following conditions are more at risk for developing a pneumothorax:
- Male gender
- 20ꟷ40 years old
- Have a smoking habit
- Suffering from lung disease, especially COPD
- Have a family history of pneumothorax
- Have you had a pneumothorax before?
Symptoms of Pneumothorax
Increased air pressure in the pleura will prevent the lungs from expanding when you inhale. As a result, symptoms such as:
- Chest pain
- Hard to breathe
- A cold sweat
- Bluish or cyanotic skin color
- Heart beat
- Weak
- Cough
When to go to the doctor
Immediately consult a doctor if you experience any of the above symptoms, especially if they appear after you have had a chest injury or you have any of the risk factors listed above.
It's important to keep in mind that testing should still be done if you have a chest injury, even if you don't have any symptoms or have only mild symptoms.
If the chest pain is unbearable or the breath is getting worse, go to the emergency room of the nearest hospital.
Pneumothorax Diagnosis
The doctor will ask about the symptoms experienced by the patient and perform a physical examination, namely by listening to the sound in the patient's chest using a stethoscope. Then, to confirm the diagnosis, the doctor will perform further examinations with:
- Arterial blood gas analysis, to measure the oxygen level in the patient's blood
- Scan with ultrasound, chest X-ray, or CT scan, to get a picture of the patient's lung condition
Pneumothorax Treatment
Treatment of pneumothorax aims to reduce pressure in the lungs so that the lungs can expand properly and to prevent recurrence of the disease. The treatment method that the doctor will choose depends on the severity and condition of the patient.
The following are some of the treatment methods that can be used to treat a pneumothorax:
1. Observation
If only a small part of the patient's lung has collapsed and there is no severe respiratory distress, the doctor may simply monitor the patient's condition.
Monitoring is done by running X-rays periodically until the patient's lungs can expand again. The doctor will also give oxygen if the patient has difficulty breathing or the oxygen level in his body decreases.
During the monitoring period, the doctor will ask the patient not to do strenuous activities or travel by airplane until the lungs recover.
2. Needle aspiration or chest tube insertion
If most of the lung has collapsed, the doctor must remove the collection of air in the pleural cavity. To do this, doctors can use the following methods:
- Needle aspiration, i.e. by inserting a needle into the patient's chest
- Installation of a chest tube, namely by inserting a tube through the incision between the breastbone, so that air can escape through this tube
3. Non-surgical measures
If the lungs still do not expand after being treated with the above procedures, the doctor will perform non-surgical measures, such as:
- Irritating the pleura so that the pleura adheres to the chest wall, so that air can no longer enter the pleural cavity
- Taking blood from the patient's arm and inserting it into a chest tube to block air leaks
- Install a one-way valve in the airway through a small tube (bronchoscope) that is inserted through the throat, so that the lungs can expand properly and no more air leaks into the pleural cavity
4. Surgery
Surgery is performed if other treatment methods are ineffective or the pneumothorax recurs. Surgery is performed to repair the leaky part of the lung.
In severe cases, the doctor will perform a lobectomy, which is the removal of the part (lobe) of the collapsed lung.
Complications of Pneumothorax
Severe pneumothorax is a dangerous condition. If left unchecked, patients can experience complications such as:
- Pulmonary edema, which is a collection of fluid in the lung sacs
- Pneumomediastinum, which is a collection of air in the middle of the chest
- Empyema, which is a collection of pus in the pleural cavity
- Hemopneumothorax, which is the collection of air and blood in the pleural cavity
- Pneumopericardium, which is a collection of air between the layers of the heart
- Hypoxemia, which is a lack of oxygen in the blood due to respiratory failure
- cardiac arrest
- Subcutaneous emphysema
Pneumothorax Prevention
It is not known how to prevent pneumothorax. However, if you have a history of pneumothorax, follow the recommendations below to prevent a recurrence of this condition:
- Stop smoking.
- Check your condition to the doctor regularly.
- Stop physical activities that are strenuous for the lungs, such as diving.