Atelectasis vs. pneumothorax: How do you treat a collapsed lung?

Atelectasis vs. pneumothorax causes | Prevalence | Symptoms | Diagnosis | Treatments | Risk factors | Prevention | When to see a doctor | FAQs | Resources

Similar at a surface level, both atelectasis and pneumothorax deal with lung collapse and closure. While these two conditions may have similar symptoms, the causes are quite different.

Unfortunately, a partial collapse or closure can be challenging to diagnose as it may not have accompanying symptoms. Only a chest X-ray can accurately show whether someone suffers from either condition, and treatment will depend on the underlying cause.

Causes 

Atelectasis 

Atelectasis happens due to conditions that make it difficult to breathe and/or cough, resulting in air sacs—known as alveoli—in the lung to deflate. It can also occur when there is pressure on the outside of the lung, such as might occur from tumors. 

Surgery is the most common cause of atelectasis. Anesthesia can affect a patient’s ability to breathe and painful recovery can cause patients to take shallow breaths. Certain lung conditions can cause atelectasis as well, including lung cancer, fluid around the lungs (pleural effusions), and respiratory distress syndrome (RDS).

Pneumothorax 

Pneumothorax is caused when air escapes the lung, filling the space between the lung and the ribs or chest wall. This makes it harder for the lung to expand, and breathing becomes difficult.

It can be caused by air blisters, called blebs, popping and sending air out into the chest cavity. This may happen due to air pressure changes or having a lung disease, such as asthma, chronic obstructive pulmonary disease, TB, whooping cough, or cystic fibrosis (CF).

Prevalence

Atelectasis

It’s not likely to happen on its own, but up to 90% of patients who have undergone surgery with general anesthesia have an increased incidence of atelectasis. One study found that the prevalence of atelectasis in bariatric surgery was nearly 38%—most of which were females older than 36. Pilots, flight attendants, scuba divers, and others who experience frequent changes in air pressure are also at risk for acceleration atelectasis.

Pneumothorax

Roughly 18 to 28 men out of 100,000 will experience what is called spontaneous pneumothorax, while only 1.2 to 6 women out of 100,000 will experience the condition. Additionally, 50% of patients with pneumothorax will experience lung collapse again.

Symptoms

Atelectasis

Symptoms of atelectasis may not be present. Otherwise, a patient may notice a cough, chest pain, or have trouble breathing.

Pneumothorax

The most frequent symptoms are shortness of breath and sharp pain in the chest or shoulder. However, a severe cause of pneumothorax may include tightness of the chest, blue tinting of the skin, lightheadedness, fatigue, rapid heart rate, shock, and fainting.

Diagnosis

Atelectasis

The most common diagnosis is through a chest X-ray and medical examination, though patients may be asked to have a chest CT scan, ultrasound, bronchoscopy, or a blood oxygen level test called oximetry.

Pneumothorax

Similarly, pneumothorax is commonly diagnosed with an X-ray though sometimes a CT scan or ultrasound may also be used.

Treatments

Atelectasis

Atelectasis can result in the body not getting enough oxygen, which can create health problems. Atelectasis is typically not life-threatening but quick treatment is important. Treatment will depend on the causation of the condition. It could be simple, such as deep breathing exercises, head tilting to drain mucus, or loosening of mucus plugs through percussion on the chest. Some patients may require more invasive methods, such as bronchoscopy, inhaled medicines (such as inhaler or nebulizer), or more directed therapies in scenarios of obstruction by a tumor.

Pneumothorax

Some patients will only need to be monitored with an oxygen treatment as they heal. However, others may need to have a needle puncture their chest to release air or have a chest tube placed between the ribs and chest cavity to drain air. If air builds up in the chest cavity, it can create tension pneumothorax, which can be life-threatening. Surgery may be required for severe cases to prevent a recurrence.

Risk Factors

Atelectasis

The risk factors of atelectasis are bed rest without moving position, shallow breathing, lung disease, anesthesia, and mucus or foreign objects blocking the airway.

Pneumothorax

Men are more prone to pneumothorax than women. Being tall, underweight, a smoker, a family or personal history of pneumothorax are all risk factors. Those who have a lung disease or require mechanical ventilation are also more likely to develop the condition. Additionally, 1 in 100 hospitalized coronavirus patients experience pneumothorax.

Prevention

Atelectasis

The best ways to prevent atelectasis are to exercise regularly, practice deep breathing, and continue regular breathing after anesthesia.

Pneumothorax

There is no way to fully prevent pneumothorax. However, smoking cessation is useful and limiting air pressure changes. The Aerospace Medical Association recommends avoiding air travel for two to three weeks after experiencing pneumothorax, and it’s best to consult a doctor before flying or scuba diving following pneumothorax.

When to see a doctor for atelectasis or pneumothorax

Both medical conditions can become quite serious if left untreated. If you notice any symptoms, including shortness of breath, difficulty breathing, or chest and shoulder pain, immediately call your healthcare provider.

Frequently asked questions about atelectasis and pneumothorax 

Can atelectasis cause pneumothorax?

Typically, atelectasis does not lead to pneumothorax. However, pneumothorax can lead to atelectasis if a patient’s lung shrinks enough to cause a blockage.

How does pneumothorax cause atelectasis?

Pneumothorax can cause the lung to shrink and deflate. If the lung deflates far enough, a patient’s alveoli will also deflate. Alveoli are microscopic air sacs inside our lungs, absorbing oxygen and doing most of the work of the respiratory system. This shrinkage can cause a blockage, which is what causes atelectasis.

How do you treat pneumothorax and atelectasis?

Treatment for these two conditions can vary. If it isn’t severe, a medical professional may only monitor a patient while administering an oxygen treatment.

However, severe cases of atelectasis may require breathing exercises, mucus draining, bronchoscopy, inhaled medicines, or even tumor treatments, depending on the cause.

Similarly, an acute case of pneumothorax will likely need a needle puncture to relieve built-up air, a chest tube, or even surgery.

Resources

• About atelectasis, Cleveland Clinic
• Pneumothorax, Tuberculosis and Respiratory Diseases
• Atelectasis, StatPearls
• Analysis of the prevalence of atelectasis in patients undergoing bariatric surgery, Brazilian Journal of Anesthesiology
• Primary and secondary spontaneous pneumothorax: Prevalence, clinical features, and in-hospital mortality, Canadian Respiratory Journal
• Pneumothorax, Harvard Health
• COVID-19 and pneumothorax: a multicentre retrospective case series, European Respiratory Journal
• Air travel and pneumothorax, Chest