Nonsmoking, Non-Alpha1-Antitrypsin Deficiency-Induced Emphysema in Nonsmokers With Healed Spontaneous Pneumothorax, Identified by Computed Tomography of the Lungs

Bense, László; Lewander, R.; Eklund, Gunnar; Hedenstierna, Göran; Wiman, Lars-Gösta

doi:10.1378/chest.103.2.433

Cited by 113 publications

(83 citation statements)

References 17 publications

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“…Quantitative CT measurements have not been widely used in previous pneumothorax research. The association between CT emphysema and history of pneumothorax in participants with COPD is consistent with prior work describing an increased appearance of emphysema-like changes on chest CT scans of patients with spontaneous pneumothorax (9,10). Our study differs from previous data regarding emphysema and pneumothorax, as we identified an association between increased percent emphysema and pneumothorax in participants with COPD, but not in smokers without COPD.…”

Section: Original Researchsupporting

confidence: 89%

“…PSP has been associated with male sex, tall and thin stature, tobacco smoking, and atmospheric pressure changes (5)(6)(7)(8). In two case-control studies, the CT scans of persons with recent PSP (including nonsmokers) were found to have significantly more emphysema-like changes in both studies as well as a lower mean radiographic density of the lungs in one of the studies (9,10). A CT study and multiple surgical studies have consistently identified blebs and bullae in patients suffering a spontaneous pneumothorax (11)(12)(13)(14)(15)(16).…”

mentioning

confidence: 99%

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Pneumothorax Risk Factors in Smokers with and without Chronic Obstructive Pulmonary Disease

Hobbs¹,

Bowler²,

Jacobson³

et al. 2014

Annals ATS

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Rationale: The demographic, physiological, and computed tomography (CT) features associated with pneumothorax in smokers with and without chronic obstructive pulmonary disease (COPD) are not clearly defined.Objectives: We evaluated the hypothesis that pneumothorax in smokers is associated with male sex, tall and thin stature, airflow obstruction, and increased total and subpleural emphysema. Methods:The study included smokers with and without COPD from the COPDGene Study, with quantitative chest CT analysis. Pleural-based emphysema was assessed on the basis of local histogram measures of emphysema. Pneumothorax history was defined by subject self-report.Measurements and Main Results: Pneumothorax was reported in 286 (3.2%) of 9,062 participants. In all participants, risk of prior pneumothorax was significantly higher in men (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.08-2.22) and non-Hispanic white subjects (OR, 1.90; 95% CI, 1.34-2.69). Risk of prior pneumothorax was associated with increased percent CT emphysema in all participants and participants with COPD (OR, 1.04 for each 1% increase in emphysema; 95% CI, 1.03-1.06). Increased pleural-based emphysema was independently associated with risk of past pneumothorax in all participants (OR, 1.05 for each 1% increase; 95% CI, 1.01-1.10). In smokers with normal spirometry, risk of past pneumothorax was associated with non-Hispanic white race and lifetime smoking intensity (OR, 1.20 for every 10 pack-years; 95% CI, 1.09-1.33).Conclusions: Among smokers, pneumothorax is associated with male sex, non-Hispanic white race, and increased percentage of total and subpleural CT emphysema. Pneumothorax was not independently associated with height or lung function, even in participants with COPD.Clinical trial registered with www.clinicaltrials.gov (NCT00608764).

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Section: Original Researchsupporting

confidence: 89%

mentioning

confidence: 99%

Pneumothorax Risk Factors in Smokers with and without Chronic Obstructive Pulmonary Disease

Hobbs¹,

Bowler²,

Jacobson³

et al. 2014

Annals ATS

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“…Emphysema-like changes were also found in 81% of patients with healed PSP who had never smoked, in contrast to none of the controls who had never smoked. 16) Although emphysema-like changes were seen in 81% of patients with PSP, no association with PAL or recurrence could be demonstrated. 17) In a publication of the British Thoracic Society in 2003 and 2010, smoking, height and age over 60 years have been reported as an independent risk factors for the recurrences in PSP.…”

Section: Discussionmentioning

confidence: 92%

Size of Pneumothorax can be a New Indication for Surgical Treatment in Primary Spontaneous Pneumothorax: A Prospective Study

Sayar

Kök

Çıtak

et al. 2014

Ann Thorac Cardiovasc Surg

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“…These changes are generally called emphysema-like changes (ELCs). ELCs were found on CTs in 81% of nonsmoking non-a 1 -antitrypsindeficient males with previous PSP, and in only 20% of ageand smoking-matched control subjects without PSP [23]. These smoking-related changes might be the site of lung tissue destruction, and contribute to the occurrence of SP.…”

mentioning

confidence: 95%

Management of spontaneous pneumothorax: state of the art

Jm¹,

Rami–Porta²,

Noppen³

et al. 2006

Eur Respir J

192

141

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Spontaneous pneumothorax remains a significant health problem. However, with time, there have been improvements in pathogenesis, diagnostic procedures and both medical and surgical approaches to treatment.Owing to better imaging techniques, it is now clear that there is almost no normal visceral pleura in the case of spontaneous pneumothorax, and that blebs and bullae are not always the cause of pneumothorax. In first episodes of primary spontaneous pneumothorax, observation and simple aspiration are established first-line therapies, as proven by randomised controlled trials. Aspiration should be better promoted in daily medical practice. In the case of recurrent or persistent pneumothorax, simple talc poudrage under thoracoscopy has been shown to be safe, cost-effective and no more painful than a conservative treatment using a chest tube. There are also new experimental data showing that talc poudrage, as used in Europe, does not lead to serious side-effects and is currently the best available pleural sclerosing agent.Alternatively, surgical techniques have considerably improved, and are now less invasive, especially due to the development of video-assisted thoracoscopic surgery. Studies suggest that video-assisted thoracoscopic surgery may be more cost-effective than chest tube drainage in spontaneous pneumothorax requiring chest tube drainage, although it is more expensive than simple thoracoscopy and requires general anaesthesia, double-lumen tube intubation and ventilation.Recommendations are made regarding the treatment of pneumothorax. In secondary or complicated primary pneumothorax, i.e. recurrent or persistent pneumothorax, some diffuse treatment of the visceral pleura should be offered, either by talc poudrage under thoracoscopy or by video-assisted thoracoscopic surgery. Moreover, all of these new techniques should be better standardised to permit comparison in randomised controlled studies.

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Nonsmoking, Non-Alpha1-Antitrypsin Deficiency-Induced Emphysema in Nonsmokers With Healed Spontaneous Pneumothorax, Identified by Computed Tomography of the Lungs

Cited by 113 publications

References 17 publications

Pneumothorax Risk Factors in Smokers with and without Chronic Obstructive Pulmonary Disease

Pneumothorax Risk Factors in Smokers with and without Chronic Obstructive Pulmonary Disease

Size of Pneumothorax can be a New Indication for Surgical Treatment in Primary Spontaneous Pneumothorax: A Prospective Study

Management of spontaneous pneumothorax: state of the art

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