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

Abstract

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).

Management of Spontaneous Pneumothorax and Post-Interventional Pneumothorax: German S3 Guideline

“…Literature: Guideline adaptation BTS 2010: Bense et al [45] de Novo Research: Cheng et al [46], Hobbs et al [47] Consensus rate: 100%…”

“…Histologically, Cheng et al [46] could demonstrate bronchiolitis in the lung tissue of PSP patients who smoked, which occurred in only 49% of non-smoking patients with PSP. Smoking in patients with pre-existing COPD increases the risk of SSP [47].…”

“…Smoking increases the probability of developing pneumothorax in lung-healthy people and patients with prior pulmonary diseases [45][46][47]. For this reason, the person should refrain from smoking or help offered to stop smoking.…”

Diagnosis and Management of Spontaneous Pneumothorax in the Emergency Department: A Review of the Most Current Clinical Evidence for Diagnosis and Treatment

“…5 Smoking cigarettes or drugs, and a taller, thin physique are risk factors for developing primary spontaneous PTX in men. 6,7 A secondary spontaneous PTX often results from an underlying disease process in the lungs, such as chronic obstructive pulmonary disease. 5 This accounts for one-third of cases of spontaneous PTX.…”

Peripheral T-cell lymphoma unspecified type presenting with a pneumothorax as the initial manifestation: A case report and literature review

“…The incidence rate of primary spontaneous pneumothorax (PSP) for males is 7.4-18 per 100,000 individuals per year, while for females is the incidence is 1.2-6 per 100,000 individuals (15,16). The clinical behavior of PSP presents as an acute onset of local pleuritic pain associated with short breath at rest (17). This pain may be mild, severe, sharp or a steady ache, but can usually be resolved within 24 h even if a pneumothorax still exists (15).…”