Pneumothorax is an accumulation of air in the space between the lungs and chest. It leads to functional limitations in the lungs and consequently to a lack of oxygen.
What is a pneumothorax?
A pneumothorax is when air has accumulated in what is known as the pleural space. The pleural space is a narrow space between the lungs and the chest. Both the outside of the lungs and the inner wall of the chest are lined with the pleura, a thin layer of skin. See polyhobbies for Meanings of Lagophthalmos.
Normally, there is a negative pressure between the two layers of skin, which sucks the lungs to the chest and prevents them from collapsing. In a pneumothorax, air enters the pleural space and the negative pressure is released.
As a result, the lungs no longer expand together with the chest when breathing and thus absorb less oxygen. There are different degrees of pneumothorax, from a slight reduction in respiratory volume to total collapse of the lungs, with one lung or both being affected.
Causes
There are various possible causes of a pneumothorax. Depending on the trigger, a distinction is made between idiopathic and symptomatic spontaneous pneumothorax, tension or valve pneumothorax and traumatic pneumothorax.
In the case of idiopathic spontaneous pneumothorax, no clear cause can be identified. All that is known is that around 90% of patients are smokers and that men are more frequently affected than women. Idiopathic spontaneous pneumothorax results from a tear in the lung tissue. Symptomatic pneumothorax forms in people with pre-existing lung disease and occurs as an additional symptom. The two types described are also known as closed pneumothorax because the air that enters comes from inside the body.
In contrast, the traumatic pneumothorax belongs to the open forms, since air penetrates from the outside into the pleural space through an injury. The tension or valve pneumothorax, which represents the most dangerous variant, is also referred to as an open type. As with a valve, only air can flow in but no longer out. This pneumothorax creates great pressure on the lungs and heart, which causes serious circulatory disorders and can lead to a life-threatening condition.
Symptoms, Ailments & Signs
A pneumothorax has different symptoms depending on its severity. If only a little air has entered the pleural space, the lungs will remain inflated and the patient will feel almost no discomfort. However, if the lung collapses, clear symptoms can be identified. The sudden onset of accelerated breathing caused by shortness of breath is typical.
The affected person begins to pant and tries to increase the air supply. In addition, there is pain in the chest, which can radiate to the shoulder. This symptom is often interpreted as a heart attack, which can trigger strong feelings of anxiety. A dry, irritating cough can also occur, which also causes pain.
If the pneumothorax resulted from an injury, skin emphysema may develop at the site of the injury; this is a clearly visible accumulation of air in the hypodermis. If a tension pneumothorax develops in the further course, the symptoms mentioned worsen and there is a risk of death. The shortness of breath increases and the skin and mucous membranes turn blue due to the lack of oxygen.
The heart begins to race and only beats very flat. Since the blood circulation no longer works, the blood pressure drops rapidly. The blood pools. Without treatment, the lung function will eventually fail completely and the cardiovascular system will collapse.
Diagnosis & History
The symptoms of a pneumothorax can vary. If only a little air has entered the pleural space, the respiratory volume is not excessively reduced and the patient hardly notices any discomfort. However, if the lungs have collapsed completely, shortness of breath occurs.
Pain occurs in the chest and abdomen as well as in the heart area, radiating to the shoulder. In the dangerous tension pneumothorax, the blood pressure drops extremely and the heart begins to race (tachycardia). The doctor will already recognize the first signs of a pneumothorax by the existing symptoms. When tapping (percussion) on the chest, darker tapping sounds can be determined due to the increase in pressure, and when listening with the stethoscope (auscultation), changed breathing sounds can be heard.
In addition, the skin may be bluish due to lack of oxygen, the blood pressure may be low and the heart rate may be higher than normal. Blood tests are used to check the oxygen level in the blood. Another diagnostic measure is an X-ray, which shows the collapsed lungs and the heart and diaphragm displaced by the pressure.
Complications
A pneumothorax always carries the risk of a life-threatening complication. Whether this happens depends on its severity. The most dangerous complication is tension pneumothorax. It represents an acute life-threatening emergency that can only be remedied by immediate emergency measures.
Tension pneumothorax occurs due to a thoracic injury, which can increase the pressure in the pleural space so much via a valve effect that the thoracic organs are compressed. Among other things, this causes the heart to be displaced to the opposite side and the superior and inferior vena cava to be crushed. The injury acts like a lip valve, which only allows air to enter the pleural space but not to escape.
As a result, more and more air is drawn in with every movement of the thorax. The tension keeps rising. The compression of the vena cava and the displacement of the mesentery causes increasing shortness of breath and leads to a drop in blood pressure. When exhaling, the chest on the affected side no longer sinks. Bulging neck veins indicate a venous congestion due to the increased pressure in the chest cavity.
Even after ventilation, the patient does not recover. In order to ensure the oxygen supply of the organism, there is a strong increase in heart rate. After all, the body can no longer be sufficiently supplied with oxygen. If left untreated, death occurs from cardiac arrest.
When should you go to the doctor?
Symptoms such as sudden one-sided chest pain, coughing or shortness of breath indicate a pneumothorax. A doctor should be consulted if symptoms become acute and do not subside within a few minutes. Cold, clammy hands, fears and pale skin indicate a tensioned chest, which must be clarified immediately by a doctor. In the event of acute shortness of breath, intense chest pain and tachycardia, an ambulance should be called immediately. The pulmonary specialist takes over the further treatment.
Depending on the symptoms and the cause of the condition, oncologists, internists and ENT doctors can also be involved. If the symptoms occur as part of a lung disease, the doctor responsible should be informed first. People between the ages of 55 and 65 are at risk. Asthmatics, fibrosis patients and people with an immune deficiency are also among the risk groups and should go to the family doctor or specialist quickly with the symptoms mentioned. The doctor can make the diagnosis and use medication and other therapeutic measures to quickly alleviate the symptoms.
Treatment & Therapy
In the case of mild idiopathic spontaneous pneumothorax, the patient often only needs bed rest and oxygen. The air in the pleural space is usually absorbed by the body and the normal negative pressure is restored by itself.
It takes between 2 and 4 weeks for the normal state to be restored. Since spontaneous pneumothorax tends to recur, it is possible to inject medication into the pleural space, which glues the two layers of skin together so that no more air can penetrate. This is known as pleurodesis.
If the pneumothorax occurs as an accompanying symptom of an existing lung disease or was caused by an injury, a drain is often placed. A tube is inserted into the pleural space to suck out the air and restore the negative pressure.
Life-threatening tension pneumothorax requires immediate emergency treatment, in which air is released with a large cannula to equalize the pressure.
Prevention
You can prevent idiopathic pneumothorax by giving up smoking. In the case of existing lung diseases, you should see a doctor early on to prevent a pneumothorax as an accompanying symptom.
If the pneumothorax was treated with a drain and breathing difficulties or chest pain reappear afterwards, the patient must contact a doctor immediately. There is a risk of respiratory failure with hypoxemia resulting in the need for ventilation. The risk depends on the extent of the lung collapse and how long the pneumothorax lasted before drainage.
Aftercare
As part of the pneumothorax follow-up care, there are a few important things for the patient to consider. For example, he is not allowed to stay at altitudes of more than 2,000 meters for a period of about four weeks, which must also be considered after an operation. In addition, the affected person has to rest physically for around two to four weeks.
Normally, work can be resumed after pneumothorax treatment, which includes physical exercise. However, sporting activities that involve intense physical exertion should be avoided until the lungs have fully developed.
After conservative therapy, it is advisable not to fly until an X-ray examination has determined that the lungs have fully expanded. This can take up to six months. The check-ups are usually carried out by the general practitioner. The patient is not allowed to use a wind instrument for three months after a pneumothorax. You should also avoid diving.
You can do that yourself
In a pneumothorax, air collects between the lungs and the chest. Despite the symptoms, breathing should be done without excitement or hectic. Fear and panic worsen the state of health of those affected and increase the existing shortness of breath.
The consumption of harmful substances such as nicotine, drugs, smoking with an e-cigarette or a water pipe must be avoided. They have a negative impact on the patient’s organism and breathing. Places where people smoke should be avoided over a wide area, as passive smoking also impairs breathing. In addition, rooms must be regularly supplied with sufficient oxygen. Nighttime sleep in particular should be closely monitored. Regular ventilation leads to stuffy air being enriched with oxygen. Daily stays in fresh air strengthen the patient and promote health. Overexertion of any kind should be avoided. The affected person needs rest and should not expose themselves to unnecessary stress.
Physical activities should be well controlled so that you don’t get overwhelmed. Stress, hectic pace and conflicts are to be avoided. The excitement can reduce well-being and make breathing worse. Sporting activities and leisure activities must be adapted to the possibilities of the body. If the person concerned notices the first irregularities, he should take a break so that sufficient regeneration can take place.