Background Acupuncture has become a more popular complementary and alternative medicine worldwide. As pneumothorax is a rare acupuncture-related adverse event (AE), it is thought to be under-recognized by acupuncturists and emergency physicians, and the public is often not aware of this potential AE resulting in delayed hospital presentation. Methods This is a case series of acupuncture-related pneumothoraces diagnosed in an emergency department (ED) in Singapore. Data was collected retrospectively from patients’ notes and prospectively from the patients over the phone. Case presentations Between 2017 and 2021, 4 out of 474 (0.84%) pneumothoraces were acupuncture related. Three of these patients consented to participate in this study. One patient developed bilateral pneumothoraces. All 3 patients claimed that they were not informed by the acupuncturists of potential serious AEs prior to acupuncture treatments and that they were not aware that such AE could occur. All 3 patients had reported their symptoms of chest pain and/or breathlessness to their acupuncturists post-treatment, but they were not advised to seek urgent medical attention. When the 3 patients had informed their acupuncturists about their diagnosis of pneumothorax, 2 of the acupuncturists did not seem to be aware of this acupuncture-related AE. Discussion When pneumothorax manifests, there is a potential need for an invasive procedure and continuous monitoring as it may devolve into a life-threatening condition with cardiovascular compromise. Early medical recognition and attention are needed to ensure optimal patient outcomes. In the appropriate population cohort, a history of prior acupuncture treatments should be included as part of history-taking assessment in patients presenting with chest pain and/or breathlessness. Conclusion Emergency physicians should be vigilant of this potentially serious and life-threatening complication for anyone presenting with chest discomfort and/or breathlessness after recently undergoing acupuncture to ensure earlier diagnosis, management, and better patient outcome.

Background: Acupuncture has become a more popular complementary and alternative medicine worldwide. As pneumothorax is a rare acupuncture related adverse event (AE) it is thought to be under-recognised by acupuncturists and emergency physicians, and the public are often not aware of this potential AE resulting in delayed hospital presentation. Aims: (1) To create further awareness and to highlight to acupuncturists and emergency physicians that pneumothorax may not be as rare as previously thought; and (2) to create public awareness about acupuncture-related pneumothorax. Methods: This is a case series of acupuncture-related pneumothoraces diagnosed in an Emergency Department (ED) in Singapore. Data was collected retrospectively from patients’ notes and prospectively from the patients over the phone.Case presentations: Between 2017 and 2021, 4 out of 474 (0.84%) pneumothoraces were acupuncture related. Three of these patients had consented to participate in this study. One patient developed bilateral pneumothorax. All 3 patients claimed that they were not informed by the acupuncturists of potential serious AEs prior to acupuncture treatments, and that they were not aware that such AE could occur. All 3 patients had reported their symptoms of chest pain and/or breathlessness to their acupuncturists post treatment, but they were advised to rest and were not advised to seek urgent medical attention. When the 3 patients had informed their acupuncturists about their diagnosis of pneumothorax, 2 of the acupuncturists did not seem to be aware of this acupuncture related AE. Discussion: When pneumothorax manifests, there is a potential need for an invasive procedure and continuous monitoring as it may devolve into a life-threatening condition with cardiovascular compromise. Early medical recognition and attention is needed to ensure optimal patient outcome. In the appropriate population cohort, history of prior acupuncture treatments should be included as part of history taking assessment in patients presenting with chest pain and/or breathlessness. Conclusion: Emergency physicians should be vigilant of this potential serious and life-threatening complication for anyone presenting with chest discomfort and/or breathlessness after recently undergoing acupuncture to ensure earlier diagnosis and management, and better patient outcome.