Spontaneous Pneumothorax

In this episode we’re going to cover the ‘atraumatic’ or ‘spontaneous’ pneumothoraces and focus on some new key guidelines from the British Thoracic Society which came out in July this year and also look at the relevant evidence on the topic.

There are pretty significant changes in the BTS guidance, it’s no longer about finding a pneumothorax, working out if it’s primary or secondary and then acting dependant on the size. It’s now moved more towards looking at how the patient is clinically, taking into account the symptomatology, any big risk characteristics, whether it’s primary or secondary and then thinking about the patients wishes and priorities and nuancing the management plan towards those. 

This episode builds on some of the concepts we discussed in our Traumatic Pneumothorax podcast, so make sure you give that one a listen before clicking play on this one!

We’ll be looking at the presentation, evidence, management and follow up, along with some trials that you can get involved in to help develop practice even further.

Once again we’d love to hear any comments or questions either via the website or social media.


Simon, Rob & James

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BTS; Pleural Disease Guidelines 2023 (includes pneumothorax)

Conservative versus Interventional Treatment for Spontaneous Pneumothorax. Brown. NEJM. 2020

Does oxygen therapy increase the resolution rate of primary spontaneous pneumothorax? Park. J thoracic Dis. 2017

BestBets: In patients with spontaneous pneumothorax, does treatment with oxygen increase resolution rate?

RCEMLearning; Spontaneous Pneumothorax

OPTICC: A multicentre trial of Occult Pneumothoraces subjected to mechanical ventilation: The final report. Clements. Am J Surg. 2021

Conservative versus Interventional Treatment for Spontaneous Pneumothorax. Brown SGA. N Engl J Med. 2020


Oxygen therapy for spontaneous pneumothorax. Northfield. BMJ 1971

Spontaneous pneumothorax; a multicentre retrospective analysis of emergency treatment, complications and outcomes. Brown. Internal Medicine Journal. 2014

Conservative versus invasive treatment of primary spontaneous pneumothorax: A retrospective cohort study. Chew. Acute Medicine and Surgery. 2014

“Nitrogen Wash-Out” in Non-Hypoxaemic Patients with Spontaneous Pneumothorax: A Narrative Review. Grasmuk-Siegi. J Cain Med. 2023



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