Collapsed Lung: Signs And Treatment

A spontaneous pneumothorax, commonly known as a collapsed lung, can happen more often than many people realize. While a collapsed lung may sound alarming, understanding the symptoms, causes and treatment options can help patients feel prepared and confident when seeking care.  

Thoracic and foregut surgeon Mary Maish, MD, MPH, an independent provider who chooses to practice at Franciscan Health Lafayette East, explains what a collapsed spontaneous pneumothorax is, what causes it spontaneous pneumothorax and how doctors treat a collapsed lung. 

Key Takeaways:  Collapsed Lung

• A collapsed lung is more common and more treatable than most people realize. 
• Chest pain and shortness of breath together should never be ignored. 
  These are the most common warning signs of a collapsed lung and should never be ignored. These and signs should prompt an immediate trip to the emergency room for evaluation. 
• Trauma and substance use are the leading causes of spontaneous pneumothorax , especially in young people. 

What Is Spontaneous Pneumothorax? 

“Spontaneous pneumothorax is just a fancy name for collapsed lung,” Dr. Maish said. “That is where your lung, which is basically like a balloon inside a box, has collapsed. So now the balloon has shrunk and has no air in it, and there's a lot of space inside the box. In the human body, the box is the chest wall made up of ribs and muscle tissue, and it really is just a box. We breathe air into our lungs, which is like the balloon, and allow our lungs to be inflated and fill the entire box. So the spontaneous pneumothorax is where the lung collapses spontaneously for no known really good reason.” 

She explains that the lungs act like balloons inside the chest cavity. When air escapes into the chest cavity, the lung can collapse. 

“So, the spontaneous pneumothorax is where the lung collapses spontaneously for no known really good reason,” she said. 

While the term “spontaneous” may sound sudden, the collapse can happen slowly over time or develop quickly after certain events. 

What Are The Symptoms Of A Collapsed Lung? 

If you have a collapsed lung, you may not notice symptoms right away, especially if the lung collapses gradually. But once the collapse reaches a certain point, symptoms usually appear. 

“It is something that usually presents with chest pain or shortness of breath,” Dr. Maish said. 

Chest pain is often felt on the side where the lung has collapsed and can sometimes be mistaken for a heart attack if it happens on the left side.  

Other symptoms of a collapsed lung include: 

• Bluish skin caused by a lack of oxygen 
• Fatigue 
• Rapid breathing or heartbeat 
• A dry, hacking cough 

What Causes A Spontaneous Pneumothorax? 

Pneumothorax can be caused by several events. There are several possible causes, with trauma being one of the most common. This can include sports injuries, car accidents, falls or broken ribs that puncture the lung. 

“For instance, it's not so uncommon for young kids playing football to have a pretty hard hit and then the lung collapses quickly and spontaneously,” said Dr. Maish. “other things that can collapse a lung include things like a car accident, fall off a horse, or a bike riding accident, where you may not even have any broken ribs that would puncture the lung and allow the air to escape into the chest cavity causing that balloon or the lung to collapse.”  

The other thing that can cause spontaneous pneumothorax would be penetrating trauma.  

“So, a gunshot wound or a knifing,” said Dr. Maish.  

Substance use is another significant risk factor for a collapsed lung. 

“There are some other things that can cause lungs to collapse and more commonly now, we're seeing a lot of young people that are vaping that can cause lung collapse,” Dr. Maish said. 

Smoking cigarettes, vaping and marijuana use can contribute to a condition called bleb disease, in which tiny air pockets form in the lung and can rupture. 

“When this occurs, these blebs are like soap bubbles just underneath the skin of the lung,” Dr. Maish said. "When you cough really hard or, as in somebody, smoking marijuana, for instance, if they're taking in a big hit of smoke or even cigarettes, it can cause them to cough. That force can then cause those small, thin-celled soap bubbles or what we call blebs to pop. That creates air inside the chest cavity or inside that box that causes that lung to collapse.” 

Other causes of collapsed lungs include changes in air pressure during flying or scuba diving, or having underlying lung diseases like COPD and lung tumors can also cause a collapsed lung. 

“But by far the most common reason for a spontaneous pneumothorax is either trauma or in a young person who's using substances,” she said. 

Who Is At Higher Risk For A Collapsed Lung? 

Very tall adolescents and young adults who experience rapid growth spurts may have a higher risk of a collapsed lung due to a mismatch between chest growth and lung growth. 

“Lung growth takes a little bit longer because it's meatier,” said Dr. Maish.  

“There is a rarer disease out there called alpha one antitrypsin disease, which is a genetic disorder that can be carried on through family,” she said, “which also has a predisposition for having a collapsed lung.”  

Age is not specifically related to a collapsed lung.  

There are no major gender differences, and the condition can affect both men and women. 

How Is A Spontaneous Pneumothorax Treated? 

First, it’s important to know that spontaneous pneumothorax is actually a very common condition. 

“Some places where I've worked, I'll treat two and three patients a week with this condition,” said Dr. Maish.  

Initial treatment for a collapsed lung 

Treatment begins with removing trapped air so the lung can re-expand. 

“We slip a small tube between the lung and the chest wall to evacuate that air,” Dr. Maish said. “Because the pressure inside the chest is negative pressure. It's, it has to be sucked out in order for the lung to expand,” Dr. Maish said. "We initially put a little tube in, we connect that tube to external suction, and then that suction allows that lung to re-expand.” 

Treating underlying causes of collapsed lungs 

Depending on what caused your collapsed lung, your next steps may range from observation to surgery. 

Observation 

"In a case where it's happened spontaneously to somebody young that has grown too fast, we can offer the option to observe to see if it happens again,” Dr. Maish said. 

Pleurodesis  

Pleurodesis is a procedure that helps the lung stick to the chest wall to prevent future collapse. 

Surgery to remove blebs 

“Those blebs are removed surgically using a special kind of staples that we have in the operating room, which allow us to excise or remove the bleb and keep the rest of the lung tissue there that's healthy,” Dr. Maish said. 

Treatment of underlying medical problems 

“Finally, if we have patients that have other reasons for why they might have their spontaneous pneumothorax, so let's say for instance, they broke some ribs, sometimes we have to do a rib fixation so that that rib can't go and poke the lung again,” Dr. Maish said. “If they have a tumor, in the lung or on the chest wall, then we would go and remove that tumor in order to prevent that from happening again.” 

Further treatment depends on the underlying cause. Options may include: 

• Observation 
• Pleurodesis, a procedure that helps the lung stick to the chest wall to prevent future collapse  
• Surgery to remove blebs 
• Rib stabilization or tumor removal if those are contributing factors 

“We often offer surgery for it, right away,” she said, noting that treatment approaches have become more proactive to prevent painful recurrences. 

Can A Collapsed Lung Be Prevented? 

“In young kids that are growing, I think the most important thing is just to be aware of it,” said Dr. Maish. 

Young kids are very resilient and can manage to have a collapsed lung without having any symptoms other than just some discomfort.   

Other measures you can take to prevent collapsed lungs include wearing protective air vests during high-risk activities like horseback riding and biking to reduce trauma to the chest.  

“Air vests are pretty thin, and they inflate like an airbag as soon as there's any traumatic impact,” said Dr. Maish, “and this really reduces the blunt force to the chest wall, but also helps to prevent rib fractures,” said Dr. Maish.  

Avoiding smoking, vaping and inhaled substances can be one of the most effective ways to lower risk. 

What Should You Do If You Suspect A Collapsed Lung? 

“The take-homes for the spontaneous pneumothorax is, if you have chest pain and shortness of breath that happen in combination, think about the possibility that maybe you have a spontaneous pneumothorax and get to an emergency room in a timely fashion, but keep yourself calm,” Dr. Maish said. 

She reassures patients that the body is resilient, and treatment outcomes for a collapsed lung are often very good with proper care. 

“It is a rare scene where anybody would actually die from a spontaneous pneumothorax,” she said. 

Finding an experienced surgeon is also important. 

“You definitely need to find somebody who has a lot of experience treating it so that the right treatment can be, found for your particular condition,” she said. “It’s not a one- size-fits-all treatment program.”