Collapsed Lung Can Be Difficult to Treat in IPF, Linked to Poorer Outcomes

People with idiopathic pulmonary fibrosis (IPF) who have had a collapsed lung, a condition known as pneumothorax, are at risk of recurring collapses, and those needing tube drainage are more likely to have poorer outcomes, a study reported.

The study, “Pneumothorax in patients with idiopathic pulmonary fibrosis: a real-world experience,” was published in the journal BMC Pulmonary Medicine.

Pneumothorax is marked by a portion of a lung, or the entire organ, collapsing due to air that leaks and accumulates between the lungs and the chest wall. It is “reportedly associated with higher mortality and recurrence rates” in people with chronic lung diseases like IPF — a disease of progressive lung tissue thickening and scarring (fibrosis) — than in those without such chronic diseases, the study reports.

Rates of pneumothorax among IPF patients are also reported to range between 2% to 20%, second only to people with chronic obstructive pulmonary disease (COPD), the researchers wrote.

In previous studies, pneumothorax has been associated with a poor prognosis in IPF patients.

However, “in clinical practice, pneumothorax associated with IPF shows a wide range of severity, from mild, involving a small area that does not require any type of treatment, to severe, which is refractory to intervention, [and its characteristics] have not been [properly] elucidated,” the investigators wrote.

Researchers at Kindai University in Japan investigated the clinical course, management strategies, and clinical outcomes of pneumothorax in a small group of IPF patients.

They reviewed the medical records of 36 of these patients (29 men and seven women, mean age of 75.5),  treated at the university’s hospital for pneumothorax 58 times over some 11 years (2008–19).

As part of the study, researchers assessed and analyzed treatment success rates for pneumothorax, as well as hospital mortality, and pneumothorax recurrence rates following hospital discharge.

In their first hospital admission, 21 (58.3%) patients had a chest tube inserted to drain the trapped air causing the pneumothorax, while the remaining 15 (41.7%) did not. Among those given chest drainage, eight (38.1%) required additional treatment, which included pleurodesis — a procedure using a glue agent or a blood patch to make patients’ lungs adhere to the chest wall.

The percentage of treatment success rates — defined as treatments that enabled patients’ lungs to be reinflated, eliminating the need for a chest tube insertion — was higher among those who simply remained in observation than among those who underwent chest drainage (86.6% vs. 66.7%).

“The total success rate of each treatment administered during all of the admissions was similar to the success rate of each treatment during the first admission only,” the researchers wrote.

Patients whose pneumothorax was determined to require chest tube drainage on a first admission remained hospitalized for about 20 days. Some were hospitalized for a longer period after the tube’s removal, due to respiratory failure or lung infections.

Hospital mortality rates were higher among patients with a first chest tube drainage compared with those on observation (38% vs. 13.3%). A total of 10 (27.7%) patients died during a first hospitalization, and 14 out of the 58 (24.1%) total hospital admissions resulted in death.

Pneumothorax recurred in nine of the 26 patients (34.6%) discharged after first admission for a collapsed lung. Of these nine patients, eight had a recurrence within one year.

“Differences between recurrence rates after each treatment were not significant. However, the recurrence rates tended to be higher in patients who had undergone chest drainage plus additional therapy,” the researchers wrote.

Taken together, the team concluded that “pneumothorax in patients with IPF was difficult to treat successfully, had a relatively poor prognosis, and showed a high recurrence rate,” they wrote, adding that “the efficacy of combined therapy, consisting of treatments in addition to chest tube drainage should be improved.”