Prognosis
Primary spontaneous pneumothorax
Patients with primary spontaneous pneumothoraces are at risk for recurrent pneumothoraces. Between 30% and 50% of patients will have an ipsilateral recurrent pneumothorax. Unless an intervention is undertaken in a patient with a first recurrence, a third and fourth event can be expected in 62% and 83% of patients, respectively. These patients are also at risk of a contralateral primary spontaneous pneumothorax, though contralateral prophylactic video-assisted thoracoscopy (VATS) is not currently recommended as only a small minority of patients experience this occurrence.[88][89]
The recurrence rates of primary spontaneous pneumothorax after VATS with stapling of the subpleural bleb and mechanical pleural abrasion and thoracoscopic talc poudrage are similar (approximately 5%). Chemical pleurodesis can be accomplished via chest tube if VATS is not readily available, or if the patient refuses VATS. Additionally, autologous blood patch and endobronchial valve placement can be considered.[75][76]
Secondary spontaneous pneumothorax
Patients with secondary spontaneous pneumothoraces are at greater risk of recurrences. Because many lung diseases occur bilaterally, these patients are typically at risk for contralateral secondary spontaneous pneumothoraces.[90] The intervention taken for a persistent air leak or a recurrent ipsilateral pneumothorax may depend on available resources.
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