Pneumothorax (collapsed lung): symptoms, causes and treatment

Asthma + Lung UK lists a sudden, sharp stabbing pain in the chest or shoulder, chest pain that gets worse when you breathe in, breathlessness, a cough, and clicking, bubbling or crunching in the chest. A pneumothorax can cause few symptoms and may heal by itself.

North Tees and Hartlepool NHS Foundation Trust says the most common symptoms are sudden shortness of breath and chest pain that may be sharp and worse with coughing and breathing, and you may also have a dry cough. If air has leaked into the muscles and skin of the chest wall there may be a swelling and a "bubble wrap" sensation when you press on your chest, and if the leak is very large you may feel faint or light-headed.

Asthma + Lung UK says to call 999 if you get sudden pain or discomfort in your chest, or pain that spreads to your arm, neck, jaw, stomach or back.

South Tees Hospitals NHS Foundation Trust says to seek urgent medical attention if you have increased shortness of breath or severe sharp, stabbing chest pain after a pneumothorax. Asthma + Lung UK warns that a tension pneumothorax, where pressure builds in the chest and squashes the other lung and heart, is a medical emergency.

The word pneumothorax comes from the Greek words for breath or air (pneuma) and chest (thorax). Asthma + Lung UK describes air leaking from a lung into the pleural space, which can squash the lung and cause it to collapse, so the condition is also called a collapsed lung. Plymouth Hospitals says the pleural space normally contains only a small amount of lubricating fluid.

Asthma + Lung UK says spontaneous pneumothorax is rare: in England, fewer than 1 in 2000 people aged 15 or above go to hospital because of one each year.

A pneumothorax is described as spontaneous when there is no known reason, or as traumatic when it follows an injury. North Tees adds an iatrogenic type, which happens after a medical procedure such as a lung biopsy.

North Tees says the most important investigation is a chest X-ray, which is usually enough to show the collapsed lung. A CT scan may sometimes be arranged for a more detailed assessment, and blood tests and heart tracings (ECGs) may be done to look for other causes. Asthma + Lung UK lists a chest X-ray, CT scan, ultrasound and blood tests.

Asthma + Lung UK says a pneumothorax can sometimes heal by itself if you have no symptoms or they are not affecting you. North Tees says a small pneumothorax may not need treatment and the lung gradually reabsorbs the air, generally taking 1 to 2 weeks, and you may be admitted overnight for another chest X-ray the next morning. Plymouth Hospitals says that if it is very small and not causing breathing difficulties it is very likely to resolve without treatment, and that you should return to clinic in 7 to 10 days.

Treatment depends on how large it is and how unwell it makes you. Local anaesthetic is used for these procedures.

Asthma + Lung UK says that if you smoke, stopping reduces the risk of it happening again, and that your healthcare professional can advise on exercise. Plymouth Hospitals suggests regular paracetamol for pain, with anti-inflammatory painkillers as an alternative, and a doctor may prescribe codeine for more severe pain.

On flying, South Tees says you should not fly at all if you currently have a pneumothorax because the trapped air can expand and cause a tension pneumothorax, and that you should have a chest X-ray first to show it has resolved and then wait at least 1 week, or 2 weeks if it was caused by an injury. Asthma + Lung UK says you should not fly until it has completely gone, usually about a week after it heals, and to tell your travel insurer.

On scuba diving, both Asthma + Lung UK and South Tees say you should not dive after a pneumothorax; South Tees says you should not scuba dive if you have ever had a spontaneous pneumothorax, though some people whose work involves diving may be suitable for an operation to prevent recurrence.

Asthma + Lung UK says that if you have had a spontaneous pneumothorax there is a risk it will happen again: around 3 in 10 people with a primary spontaneous pneumothorax have another, and up to 4 in 10 with a secondary one. If it happens more than once on the same side you might have a small operation to make sure it cannot happen again.

South Tees says the risk of recurrence does not fall significantly for at least 1 year and is higher in people with coexisting lung disease. If other family members have had a pneumothorax, Asthma + Lung UK says your healthcare professional should see whether you have a genetic condition such as Marfan syndrome or Ehlers-Danlos syndrome.

Asthma + Lung UK says its information covers pneumothorax in both adults and children, and that the symptoms are the same in children. Primary spontaneous pneumothorax is more common in younger people aged between 15 and 34, so teenagers can be affected.

The sources used here do not give specific guidance for pregnancy. Sudden chest pain or breathlessness in pregnancy should be assessed urgently, because it can have several causes, so call 999 or NHS 111.

On the NHS, a pneumothorax is usually diagnosed in an emergency department or by a GP sending you straight to hospital for a chest X-ray, with treatment by the respiratory or emergency team and a follow-up chest X-ray in clinic.

Because sudden chest pain and breathlessness need urgent assessment, the emergency route is the safest first step. For recurrence, flying and diving questions, a respiratory physician in either the NHS or private sector can advise on your own risk and any preventive operation.