How Do You Know If You Have A Collapsed Lung?

Overview

Pneumothorax, often referred to as a collapsed lung, occurs when air enters the ribcage (located between the lung and the chest wall). This build-up of air increases pressure against the lung, resulting in limited lung expansion during normal breathing. The severity of pneumothorax varies from requiring no treatment to life-threatening, which is contingent on the size of the air sac in the pleural space, and the pressure exerted on the lungs.¹ Symptoms commence almost immediately, often beginning with chest pain.² Other common symptoms of a collapsed lung include a sharp stabbing pain in the chest which intensifies when breathing in, shortness of breath, bluish skin caused by oxygen deficiency, fatigue, rapid breathing, increased heart rate, and a dry, hacking cough.²

How do you get a collapsed lung?

Causes

• Primary spontaneous pneumothorax: This occurs in the absence of any underlying lung disease when small air blisters (blebs) develop in the lungs. These air blisters may rupture, allowing air to leak into the pleural cavity surrounding the lung.³ 
• Secondary spontaneous pneumothorax: Occurs in the presence of an existing underlying lung condition. Lung tear and collapse are likely to occur in the presence of damaged lung tissue, which occurs during chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), cystic fibrosis, sarcoidosis, lung cancer, tuberculosis, or pneumonia.³ 
• Traumatic injury: rib fracture or penetrating injury (for example, stab or gunshot wound) that causes damage to the lung or chest can cause pneumothorax. Tension pneumothorax is a life-threatening form of pneumothorax that results in the collapse of major blood vessels that return blood to the heart due to increased pressure in the pleural space.¹ A traumatic injury can be classified as open (open passage from the external environment into the pleural space through the chest wall) or closed (chest wall remains intact). Medical procedure complications can also lead to pneumothorax. For example, placing a central venous catheter, a surgery that requires entry into the chest cavity, biopsy of lung tissue, administration of positive pressure ventilation, etc.¹ Some traumatic injuries may occur during a physical assault, a car crash, or an acupuncture procedure.³ 

Risk factors

• Sex: People assigned male at birth (AMAB) have a higher risk of developing pneumothorax with primary spontaneous pneumothorax (PSP) commonly occurring in tall, thin males aged 10-30.⁴ 
• Smoking: Smoking is closely related to pneumothorax. Studies have shown that 91% of patients diagnosed with PSP are current or past smokers. Smoking causes emphysema, which may lead to the development of bullae (holes in the lung) which could rupture. Smoking associated with bronchiolitis also increases the risk of pneumothorax in smokers.⁴ 
• Height: Bleb formation on the lung can occur in two ways. The first risk factor is congenital, wherein the upper pulmonary lobe grows at a faster rate than the vasculature, causing impaired blood supply and the development of bullae. The second involves pleural cavity pressure, which becomes more negative at the apical region of the lung. In tall individuals, the negative pleural cavity pressure and alveolar pressure increase. This increase causes numerous bullae formations and pneumothoraces.⁴
• Genetics: In rare cases, PSP occurs in individuals with specific inherited genes, particularly autosomal dominant inheritance with a variety of penetrations. Risk factors include HLA haplotype A2B40, alpha-1 antitrypsin phenotypes M1M2, and FBN1 mutation.⁴ 
• Presence of another medical condition: An underlying pulmonary disease such as asthma, pneumonia, pulmonary abscess, pertussis (whooping cough), lung cancer, and COPD increase the risk of pneumothorax. Patients diagnosed with Marfan syndrome are at a higher risk of developing pneumothorax.⁴
• Flying or diving: Air pressure changes when scuba diving or travelling at a higher altitude, increasing the risk of bleb formation and lung compression.³ 
• Previous pneumothorax: has been shown to increase the risk of another occurrence.³

Signs of a collapsed lung 

Symptoms of pneumothorax occur almost immediately, often starting with chest pain. Other common symptoms include shoulder pain which intensifies with deep breaths or coughs, shortness of breath, rapid breathing, increased heart rate, and flaring nostrils.² A severe pneumothorax may cause bluish skin colour due to oxygen deficiency, chest tightness, lightheadedness, fainting, easy fatigue, abnormal breathing patterns or increased effort to breathe, shock, and collapse.⁵

How severe is a collapsed lung?

Potential complications

Complications of pneumothorax include effusion, haemorrhage, empyema, respiratory failure, ventilatory dependence, pneumomediastinum, arrhythmias, and unstable haemodynamics.⁶ Possible complications during treatment include major pain, subcutaneous emphysema, bleeding, infection, rare reinfection, and pulmonary oedema.⁶ 

When to seek medical attention

If you experience sudden sharp chest pain and breathlessness (which may spread to the shoulders and back), consult your doctor immediately to rule out the possibility of pneumothorax and prevent long-term health conditions. In the case of an injury, accident, physical assault, or post-medical procedure complication, dial 999 in the UK or your own local emergency number and seek medical help immediately.

Diagnosis and treatment 

Diagnosis 

An initial physical exam will be performed by the doctor using a stethoscope, which involves listening to your chest as you breathe to investigate any hollow sounds. Your doctor may suggest an arterial blood gas test to analyze carbon dioxide and oxygen levels in your blood (high CO₂ and low O₂ could indicate the presence of a collapsed lung).²

Symptoms of pneumothorax could be inconclusive and indeterminate, particularly in the case of a small PSP. A medical imaging test (chest X-ray, ultrasound, CT scan) is usually required to confirm the presence of pneumothorax. 

Treatment

Treatment is selected depending on the patient’s health condition and the size, expansion, and cause of pneumothorax. Treatment is aimed at relieving the pressure and allowing the lung to re-expand.

In the event of a small pneumothorax and minor tear in the lung, the leak usually heals itself within a few days, and the trapped air is gradually absorbed by the body.³ Over-the-counter painkillers can be used to provide temporary pain relief, and oxygen may be given in the event of breathlessness.³

In the case of a more severe pneumothorax, the excess air can be removed by:

• Aspiration: A needle is inserted into the air-filled space and the air is sucked out using a syringe.³ The needle is inserted between the ribs into the air-filled space which is pressing onto the collapsed lungs.² 
• Chest drain: A flexible plastic tube is inserted into the chest wall to permit air drainage, allowing re-inflation of the lungs.³
• Pleurodesis: If pneumothorax persists despite aspiration or chest drain, an operation may be required to seal the weak areas of the lung where air leaks are occurring or remove the collapsed portion of the lung.^2,3 

Summary

Pneumothorax is a medical condition involving the abnormal collection of air in the pleural space between the lung and chest wall. Pneumothorax can be classified into primary spontaneous pneumothorax, secondary spontaneous pneumothorax, and traumatic pneumothorax based on the cause and symptoms commencing with chest pain and breathlessness. Consult your doctor to get the most effective treatment to manage your symptoms and prevent any long-term health condition.