Synopsis
Recognise secondary spontaneous pneumothorax as high-risk loss of lung volume in established lung disease, relieve physiological compromise promptly, and plan recurrence prevention with respiratory and thoracic expertise.
- Secondary spontaneous pneumothorax occurs without trauma in a person with underlying lung disease, commonly COPD, interstitial lung disease, cystic fibrosis, infection, malignancy or cystic lung disease.
- The same radiographic air rim causes more severe hypoxaemia and breathlessness than in primary pneumothorax because the remaining lung is already impaired.
- Pleuritic pain, sudden dyspnoea and unilateral reduced breath sounds are typical, but examination can be subtle in hyperinflated or fibrotic lungs.
Key red flags
New unilateral pleuritic pain or breathlessness with a pleural line and absent peripheral lung markings in a person with established lung disease; oxygen need may exceed apparent radiographic size.
Investigation priorities
Define immediate respiratory compromise and hypercapnic risk in the underlying lung disease.
Management branches
Pneumothorax is suspected with severe respiratory or haemodynamic compromise.
- Call for senior emergency and critical-care help, give high-concentration oxygen initially if critically ill, and monitor continuously.
- Perform immediate decompression using the locally approved technique and trained expertise; do not wait for a chest radiograph.
Imaging confirms secondary spontaneous pneumothorax without tension.
Key medicines
Controlled oxygenTitrate to the BTS target saturation; in COPD or another hypercapnic-risk state use the lower target pending blood gases unless critically hypoxaemic.
Multimodal analgesiaUse regular non-opioid treatment and carefully titrated opioid rescue according to frailty, renal function, bleeding risk and respiratory status.