Respiratory and sleep medicine
Pneumothorax
Primary versus secondary spontaneous pneumothorax, the symptom-led BTS 2023 and ERS/EACTS/ESTS 2024 approach, the Australian PSP trial, when to drain or refer for surgery, and the advice on flying, diving and smoking.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Air in the pleural space. Primary spontaneous pneumothorax (PSP) occurs without known lung disease, typically in tall, thin young men who smoke (tobacco or cannabis). Secondary (SSP) complicates lung disease and is more dangerous because there's little reserve.
- Tension pneumothorax is a clinical diagnosis. Decompress without waiting for imaging (see chest pain).
- BTS 2023 and ERS/EACTS/ESTS 2024 are symptom-led, not size-led. Many PSPs can be managed conservatively, supported by the Australian and NZ PSP trial.
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Sources
- Roberts ME et al. British Thoracic Society Guideline for pleural disease. Thorax 2023;78(Suppl 3):s1-s42British Thoracic Society (Thorax), 2023
- Walker S et al. Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax. Eur Respir J 2024 and Eur J Cardiothorac Surg 2024European Respiratory Society, European Association for Cardio-Thoracic Surgery, European Society of Thoracic Surgeons, 2024
- Brown SGA et al. Conservative versus interventional treatment for spontaneous pneumothorax (PSP trial). N Engl J Med 2020;382:405-15AU/NZNew England Journal of Medicine, 2020
- Coker RK et al. BTS Clinical Statement on air travel for passengers with respiratory disease. Thorax 2022;77:329-50British Thoracic Society, 2022
- Hallifax RJ et al. Ambulatory management of primary spontaneous pneumothorax: an open-label, randomised controlled trial (RAMPP). Lancet 2020;396:39-49The Lancet, 2020
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy