Primary spontaneous pneumothorax (PSP) affects young healthy
people with a significant recurrence rate. Recent advances in
treatment have been variably implemented in
clinical practice. This statement reviews the latest developments and
concepts
to improve clinical management and stimulate
further research.
The European Respiratory Society's Scientific Committee established a multidisciplinary team of pulmonologists and surgeons
to produce a comprehensive review of available scientific evidence.
Smoking remains the main risk factor of
PSP. Routine smoking cessation is advised. More prospective data are
required to better
define the PSP population and incidence of
recurrence. In first episodes of PSP, treatment approach is driven by
symptoms
rather than PSP size. The role of bullae rupture as
the cause of air leakage remains unclear, implying that any treatment
of PSP recurrence includes pleurodesis. Talc
poudrage pleurodesis by thoracoscopy is safe, provided calibrated talc
is available.
Video-assisted thoracic surgery is preferred to
thoracotomy as a surgical approach.
In first episodes of PSP, aspiration is
required only in symptomatic patients. After a persistent or recurrent
PSP, definitive
treatment including pleurodesis is undertaken.
Future randomised controlled trials comparing different strategies are
required.
Full text:
http://erj.ersjournals.com/content/46/2/321.abstract?etoc
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