This guide explains all you need to know about the condition known as pneumothorax or collapsed lung. We will discuss how pneumothorax is diagnosed and the treatment options available in Singapore.
Whether you have a very mild case that resolves on its own or a more serious, recurring case that requires surgery, we will go into detail about the various treatment options for pneumothorax in Singapore so you know what to expect.
You will also find some tips for taking care of yourself post-surgery and precautions to take after recovery— let’s go!
What is Pneumothorax?
Pneumothorax is a condition that is also referred to as ‘collapsed lung’.
Pneumothorax happens when air leaks into the space between the lung and the rib cage known as the pleural cavity. The pressure exerted by the air causes the lung to collapse. Below are some quick facts about the condition:
- Pneumothorax can involve the complete collapse of a lung or the collapse of one or more portions of the lung.
- Pneumothorax usually affects only one lung, although it is possible but rare that both lungs are affected.
Minor cases of pneumothorax can sometimes resolve on their own within a few days. However, in certain cases, pneumothorax can be life-threatening, so it is advisable to seek medical attention immediately after the onset of symptoms.
What Are the Symptoms of Pneumothorax?
Symptoms of pneumothorax can include [1][2]:
- Sharp and sudden onset of chest pain (pleuritic pain)
- Shortness of breath
- Cold Sweats
- Chest tightness
- Tiredness
- Tachycardia or quickening of heart rate
- Turning blue
Symptoms often occur quite suddenly. While some minor cases of pneumothorax can resolve on their own, symptoms can also worsen over time, and in some cases, the condition can be life-threatening.
I
f you experience severe chest pain or you are finding it increasingly difficult to breathe, you should seek emergency care immediately.
What Causes Pneumothorax?
Pneumothorax is not often caused by an underlying health condition.
Pneumothorax usually arises without any apparent reason in patients without significant lung disease. When that happens, it is termed primary spontaneous pneumothorax and this is the most common presentation.
In patients with lung disease, this condition is termed secondary spontaneous pneumothorax, with the most common cause being chronic obstructive pulmonary disease [3].
In this section we will discuss the common causes of pneumothorax [4]:
Primary Spontaneous Pneumothorax
This usually happens in young adolescents, teens who are tall, thin and lanky. There is usually no underlying cause.
Small air sacs or air blisters can form on the lungs for no apparent reason, even if you have no health issues.
They can be present in the lungs for a long time before rupturing. Upon rupturing, it causes air to leak into the pleural cavity.
Lung Disease
Any thinning, abnormality or damage in lung tissue makes the lung more susceptible to collapse. Below are some conditions that may damage the lung:
- Emphysema
- Pneumonia etc
These conditions can cause lung damage that could potentially raise one’s risk of pneumothorax.
Chest Injury
Trauma to the chest can cause pneumothorax. Some potential causes include:
- Accidents — broken ribs, hard impact to the chest from contact sports.
- Assaults — A wound to the chest caused by a physical assault.
- Medical procedures affecting the chest — lung biopsy
Mechanical Ventilation
Being placed on a ventilator can cause pneumothorax or worsen existing pneumothorax.
Who is at Risk of Pneumothorax?
The following can raise your risk of pneumothorax.
Of all of the above symptoms, the factor that is most within your control is smoking, so do consider quitting if you have not already done so.
Smoking
A major risk factor for primary spontaneous pneumothorax is smoking, whether or not the patient has emphysema or some other type of lung disease [5].
Lung disease
The major underlying causes of secondary pneumothorax are:
- Chronic obstructive pulmonary disease
- Asthma
- Tuberculosis
Some other conditions that could potentially lead to pneumothorax include:
- Pneumonia
- Chronic bronchitis
- Lung cancer [6]
Mechanical Ventilation
The use of mechanical ventilation places one at higher risk of pneumothorax [7].
Previous pneumothorax
Those who have had a previous incidence of pneumothorax are at a higher risk of experiencing another.
This risk can be 30% after the first episode and 50-60% after the second episode if they have been treated conservatively during the first episodes.
[8].
Genetics
Some people are more genetically predisposed to pneumothorax.
For example, people with collagen disease disorders.
Gender
Overall, men have a higher risk of pneumothorax than women. The mean age at diagnosis is also significantly lower in men than in women [10].
When it comes to primary spontaneous pneumothorax:
- Men aged 20 to 30 — tend to be most susceptible to pneumothorax due to air blisters
- Women aged 30 to 40 — most susceptible to pneumothorax due to endometriosis and the menstrual cycle [11].
Age
Patients suffering from pneumothorax caused by air blisters tend to be aged between 20 to 40 years old [12], while those suffering from primary spontaneous pneumothorax tend to be aged between 10 and 30 [13].
Height and Weight
People with a tall and thin body shape tend to be more susceptible to primary spontaneous pneumothorax [14].
How Is Pneumothorax Diagnosed in Singapore?
When you first see a doctor after the onset of pneumothorax symptoms, you will most likely be given a chest X-ray. This is the most common procedure to diagnose pneumothorax.
In some cases, a computed tomography (CT) scan will be performed following the chest X-ray [15].
Other procedures that your doctor might use to diagnose pneumothorax include:
- Chest ultrasound
- Bronchoscopy [16]
Complications of Pneumothorax
Pneumothorax can lead to a host of complications which can have serious consequences. These complications include the following [17]:
- Effusion
- Hemorrhage
- Empyema
- Respiratory failure
- Pneumomediastinum
- Arrhythmias
- Unstable hemodynamics
In addition, treatment of pneumothorax can give rise to the following complications [18]:
- Major pain
- Subcutaneous emphysema
- Bleeding and infection
- Rare re-expansion pulmonary edema
What Should You Do if You Suspect That You Have Pneumothorax?
If you experience symptoms related to pneumothorax, your first response should be to see a doctor as soon as you can.
Your doctor will be able to:
- Offer a diagnosis
- Monitor the condition
- Prescribe treatment if necessary.
In the meantime, you should:
- Get as much rest as possible
- Avoid talking loudly or too much
- Avoid smoking.
Treatment of Pneumothorax in Singapore
Minor Cases of Pneumothorax
In very minor cases of pneumothorax, your body will be able to heal itself in a few days as the leak gradually goes away.
In these cases, you might be prescribed painkillers to deal with the pain. Your doctor will monitor the condition and perform another x-ray in a few days to be sure that the pneumothorax is gone.
During the recovery period, follow all of your doctor’s recommendations closely and make sure you return for all follow-up visits so that he or she can monitor your progress.
Serious Cases of Pneumothorax
However, not all cases of pneumothorax can be resolved so easily. If you have a more serious case of pneumothorax, or if the degree of collapse is expanding, a course of treatment will be prescribed.
Treatment of pneumothorax involves removing the excess air in your pleural cavity. This can involve one or more of the following procedures [19][20]:
Needle aspiration — Involves inserting a needle into your pleural cavity and removing the air using a syringe and a very thin tube. This procedure may require hospitalisation for one or more days.
Chest drain — Your chest will be numbed and a plastic tube called a chest drain will be inserted. The chest drain will remove the air in your pleural cavity to enable your lung to re-inflate. This procedure may require 2-3 days of hospitalisation.
Surgery — In some cases, surgery is necessary. These cases include: (i) If the pneumothorax recurs (ii) if it is bilateral (both sides) (iii) if the pneumothorax is persistent, (iv) in cases of some occupational conditions.
Surgery for Pneumothorax — What Is Done?
The principles of surgery for pneumothorax involve stopping the leaking of air from the lungs and to appose the two pleural surfaces so that the pneumothorax doesn’t recur.
This surgery is done through keyholes (2-3), each hole about 5-10mm in size and it is called video-assisted thoracic surgery.
The process of stopping the air leak is called bullectomy (removing the bleb) and mechanical and chemical pleurodesis, wherein mechanical abrasion and talc (clay mineral)are used to bring the pleural surfaces to stick.
After the operation, the patient will have a drain for 2-3 days and it will be removed before the patient goes home.
Cost of Pneumothorax Treatments in Singapore
There are three main costs to pay when you get treated for pneumothorax in Singapore.
Cost of diagnosing the condition — varies depending on the procedure being used, with a chest x-ray being significantly cheaper than a CT scan.
Treatment of the condition if necessary — This might include procedures such as needle aspiration or a chest drain.
Hospitalisation if necessary — The number of days will depend on the seriousness of your condition as well as the treatment option you are using.
The price estimates below are for secondary pneumothorax with chronic obstructive pulmonary disease. All prices are in Singapore dollars.
Diagnosis:
Chest x-ray: $61 (For patients above 40 years old)
CT scan with contrast: $650
Treatment:
Procedure: $10,000 to $12,000 (excluding anaesthetist’s fee, consumables, and other medical fees)
Hospitalisation
Daily hospital charges: From $35 to $3,000 per day depending on hospital and ward type
Primary pneumothorax cases are usually classified as emergency cases and thus are charged differently.
Is the Treatment of Pneumothorax Medisave Claimable in Singapore?
In cases where a pneumothorax diagnosis leads to hospitalisation, you can use your Medisave to pay for up to $450 worth of hospital charges per day.
Surgery is also Medisave claimable but the amount depends on the surgical procedure.
If you have additional medical insurance such as an Integrated Shield Plan, you will also be able to make a claim for a certain percentage of your bills according to your insurance policy.
How Long Does It Take to Recover From Pneumothorax?
A minor case of pneumothorax may go away in a few days without treatment in a healthy adult.
However, if you require treatment, you can expect to recover in about one or two weeks.
You might be hospitalised or expected to make repeat visits to your doctor for review during this time.
What Can You Expect After Surgery for Pneumothorax?
If you have to undergo surgery, you are likely to be hospitalised for 2-3 days following the procedure. During that time, medical staff will:
- ensure that you have sufficient pain relief
- monitoring your breathing
- supply you with oxygen if necessary [23]
You will also be given a chest drain after your surgery to ensure that fluid and air does not collect in your chest cavity. The drain will stay in place until the doctor is sure that you no longer need it.
When you are discharged, your doctor will schedule a follow-up appointment to repeat a chest x-ray to review your current condition and check on your wounds.
You will be sent home with washable dressings and will be able to take baths as usual to maintain your hygiene.
When recuperating at home, you might find the movement of the chest muscles uncomfortable, such as when you are laughing or coughing. Hugging a pillow against your body when you are about to cough can relieve some of the pain.
Above all, get as much rest as you can and if all goes well you should eventually find your pain and fatigue dissipating over time.
What Can You Not Do After Pneumothorax?
Avoid Flying
You should avoid flying while still suffering from or shortly after recovering from pneumothorax [24].
Changes in cabin pressure on the plane can cause the air in your pleural cavity to expand, which can collapse your lung even further. Only fly when your doctor gives you the green light, typically at least 3 weeks after your pneumothorax diagnosis.
Avoid Scuba Diving
If you have been diagnosed with pneumothorax, it is advisable to avoid scuba diving permanently due to the risk of your suffering another lung collapse while underwater [25].
A surgical procedure called a bilateral surgical pleurectomy can enable you to scuba dive again [26]. However, even then, you should not do so before your doctor gives you the go-ahead.
Quit Smoking
Finally, if you are a smoker, it is a good idea to quit smoking as continuing will put you at greater risk of another pneumothorax.
Can You Exercise After Pneumothorax?
Yes. After recovering from pneumothorax, it is important to reincorporate some exercise into your life so that your lungs can re-expand.
If you have had surgery, you should embark on an exercise and physiotherapy plan with the advice of a doctor [27].
You might find yourself getting breathless and tired at the start, but this should ease as your lungs recover.
Conclusion
Pneumothorax is not always preventable, but smoking is the biggest risk factor that you can control.
So, if you are concerned about getting pneumothorax or you’re currently diagnosed with it, quitting smoking is the biggest step you can take to prevent another lung collapse.
If at any time you suspect that you are suffering from pneumothorax, schedule an appointment with your doctor.
He or she will be able to take a closer look at your lungs and prescribe treatment as soon as possible in order to relieve the symptoms and get rid of the pneumothorax as soon as possible.
Having pneumothorax can be scary, but it is also a relatively common condition, so rest assured that your doctor will be able to help you and put you on the road to recovery.
