Secondary spontaneous pneumothorax

Secondary spontaneous pneumothorax is a pneumothorax that occurs without a precipitating external event in a patient with lung disease (most commonly chronic obstructive pulmonary disease [COPD], but also asthma, interstitial lung disease or cystic fibrosis).

Secondary spontaneous pneumothorax is initially managed with analgesia, and oxygen if the patient is hypoxaemic. Titrate flow of oxygen to target SpO₂ levels; see here for more advice. Early pleural intervention and hospitalisation for observation are more likely to be required for secondary spontaneous pneumothorax compared with primary spontaneous pneumothorax. Intercostal catheter drainage is usually recommended. Catheter aspiration is less likely to be successful.

Patients with untreated pneumothorax should not be put on positive pressure ventilation (eg continuous positive airway pressure [CPAP], bilevel positive airway pressure [BPAP]).