Tension pneumothorax awareness

Overview

A tension pneumothorax is a life-threatening condition where air gets trapped in the space between your lung and your chest wall. The trapped air pushes against your lung, causing it to collapse, and also presses on your heart and the other lung, making it very hard to breathe and dangerously affecting your circulation.

No, tension pneumothorax is not common, but it is a serious emergency when it occurs.

It can affect anyone, but people with certain lung diseases (like COPD or cystic fibrosis), those who have had a chest injury, tall thin individuals, and people on mechanical ventilation are at higher risk.

Symptoms

Common symptoms

• Sudden, sharp chest pain on one side
• Severe shortness of breath
• Rapid breathing
• Rapid heart rate
• Blue or grey colour of the skin, lips, or nails (cyanosis)
• Feeling very anxious or restless

Symptoms in children

• Child may look very distressed or restless
• Grunting sounds when breathing
• Flaring of the nostrils
• Sucking of the chest or belly (retractions)
• Refusing to feed or drink

Symptoms in older adults

• Confusion or drowsiness
• Sudden worsening of existing breathing problems
• Dizziness or feeling faint
• May not complain of pain as clearly

Causes

Main causes

• Chest injury: like a broken rib, stab wound, or accident that punctures the lung
• Lung disease: conditions such as COPD, asthma, cystic fibrosis, or tuberculosis that weaken the lung tissue
• Medical procedures: such as mechanical ventilation or lung biopsy
• Spontaneous: sometimes a small air blister (bleb) on the lung bursts for no apparent reason

Risk factors

• Smoking cigarettes
• Being tall and thin (for spontaneous pneumothorax)
• Having had a pneumothorax before
• Having a family history of pneumothorax
• Certain lung diseases (e.g., emphysema, fibrosis, infection)

When to see a doctor

See a doctor urgently if:

• If you have sudden chest pain and severe difficulty breathing, call your local emergency number immediately.
• If you have been diagnosed with a lung condition and suddenly feel worse with pain and breathlessness, get emergency help.

Book a routine appointment if:

• If you have mild chest discomfort and slight breathlessness but no emergency signs, see a doctor promptly.

Diagnosis

A doctor will suspect tension pneumothorax based on your symptoms and a physical exam. They will listen to your breathing, check your pulse and blood pressure, and look for signs of a collapsed lung.

Tests that may be done

• Chest X-ray: often the first test to see if air is trapped
• CT scan (computed tomography): gives a detailed image of the chest
• Ultrasound: can be done quickly at the bedside

What to expect at your appointment

In the emergency department, the care team will act very quickly. They may place a needle or tube into your chest to release the air pressure. You will be given oxygen and monitored closely. The procedure can be uncomfortable but provides immediate relief.

Treatment

Treatment for tension pneumothorax focuses on quickly removing the trapped air so the lung can re-expand and the heart can work normally. This is always done in a hospital emergency setting.

Self-care at home

• Do not attempt any home treatments—this is a medical emergency.
• Call for emergency help immediately.

Medical treatments

The main treatment is a needle decompression (inserting a large needle into the chest to let air out) followed by insertion of a chest tube (thoracostomy) connected to a drainage system. You may also be given extra oxygen. In some cases, surgery may be needed to repair the lung and prevent it from happening again.

When is surgery considered?

Surgery (such as pleurodesis or wedge resection) may be recommended if you have had a tension pneumothorax more than once, if the air leak does not close, or if you have a lung disease that weakens the tissue.

Living with this condition

After treatment, you will need time to recover. You may feel tired and have some chest discomfort for a few weeks. Avoid heavy lifting, sports, or anything that puts strain on your chest until your doctor says it is safe.

Lifestyle tips

• If you smoke, stopping smoking is the most important step to prevent recurrence.
• Avoid scuba diving and flying in unpressurised aircraft for at least several weeks after recovery.
• Attend all follow-up appointments with your doctor.

Diet and exercise

Eat a balanced diet to support healing. Gradually increase your activity as advised—start with short walks and slowly build up. Do not rush back to intense exercise.

Mental health and emotional wellbeing

An episode of tension pneumothorax can be frightening. You may feel anxious about it happening again or about breathing problems. Talk to your doctor or a counsellor if these feelings affect your daily life.

Prevention

It is not always possible to prevent tension pneumothorax, but you can lower your risk by not smoking, managing any lung conditions carefully, and avoiding activities that might cause chest injury (like contact sports if you are at risk).

Vaccines

For people with chronic lung disease, staying up to date with the flu vaccine and pneumococcal vaccine can help prevent lung infections that might trigger a pneumothorax.

Screening programmes

There is no routine screening for pneumothorax. However, if you have a high risk (e.g., tall thin male smoker with a family history), your doctor may recommend an occasional chest X-ray.

Complications

If left untreated

• The affected lung remains collapsed and cannot function
• Pressure on the heart reduces blood flow, leading to shock
• Cardiac arrest (heart stops) if emergency treatment is delayed

Long-term outlook

With prompt emergency treatment, the outlook is very good. Most people recover fully without long-term problems. The key is recognising the symptoms and getting help immediately.

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