Private collapsed lung clinic in London, same-day respiratory.

Who it happens to

• Primary spontaneous — in people with no known lung disease. Classically tall, thin young men aged 15 to 35, often smokers, frequently at rest rather than during exertion. Small blebs on the lung surface rupture.
• Secondary spontaneous — in people with existing lung disease, most often COPD. More dangerous, because the remaining lung has less reserve.
• Traumatic — after injury, a rib fracture, or a medical procedure.
• Catamenial — a rare form linked to endometriosis, occurring around periods.
• Smoking raises risk many times over, and cannabis smoking particularly so.

Symptoms

• Sudden sharp chest pain on one side, often worse on breathing in
• breathlessness, ranging from mild to severe
• a dry cough, and sometimes pain referred to the shoulder tip
• small ones can cause surprisingly little — some are found incidentally on a chest X-ray

Treatment

• Observation for small pneumothoraces in people who are not breathless — air is reabsorbed over days to weeks. Oxygen speeds this up.
• Needle aspiration to draw the air out, often successful for a first primary pneumothorax.
• Chest drain where aspiration fails, the pneumothorax is large, or there is underlying lung disease.
• Ambulatory devices allow some people to go home with a one-way valve rather than being admitted.
• Surgery (VATS with pleurodesis) for recurrence, persistent air leak, or in people whose occupation makes recurrence dangerous — pilots and divers.

Recovery and recurrence

• Stopping smoking dramatically reduces recurrence — this is the single most effective thing you can do.
• Avoid heavy lifting and strenuous exercise for a few weeks; build back gradually.
• Return to work depends on the job — desk work within days, heavy manual work several weeks.
• Seek help immediately if the pain or breathlessness returns, as recurrence is common and often on the same side.
• Follow-up chest imaging confirms resolution before you are discharged.