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Войти в исследования Journal of thoracic disease · 2026
Clinical phenotypes of secondary spontaneous pneumothorax (SSP) in different underlying lung diseases: a retrospective study and literature review on the clinical heterogeneity in this single entity.
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Cheng Hei-Shun, Wong Charles, Chiu Pui-Hing, Yew Vinson Nelson, Wong Chi-Chung Jeffrey, Tong Chun-Wai, Miu Pui-Ling Flora
Аннотация
BACKGROUND: The clinical outcome of secondary spontaneous pneumothorax (SSP) was mostly evaluated in chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD) patients whereas data were limited in non-COPD/ILD-related pneumothorax. This study aimed to describe the clinical outcome of pneumothorax secondary to different pulmonary conditions.
METHODS: A retrospective observational study was conducted on SSP patients in a Hong Kong hospital. Clinical outcome of pneumothorax secondary to different underlying lung diseases including persistent air leak (PAL), 2-year post-discharge pneumothorax recurrence and all-cause mortality were evaluated. Logistic regression and cox regression analysis were applied for covariates adjustment.
RESULTS: Of the 223 SSP patients enrolled, 32 (14.3%) had acute chest infection and 191 (85.7%) had chronic lung diseases. The acute chest infection group had higher risk of PAL >14 days (40.6% vs. 17.8%; P=0.003), longer hospitalization (24 vs. 13 days; P=0.001) and higher all-cause mortality rate (25.0% vs. 12.0%; P=0.049) than chronic disease group. Among those with chronic lung diseases, COPD/ILD-related pneumothorax led to higher PAL risk (>2 days: OR: 2.14, 95% CI: 1.01-4.54, P=0.046; >14 days: OR: 4.02, 95% CI: 1.49-10.88, P=0.006) and prolonged hospitalization (14 vs. 12 days; P=0.02) but similar post-discharge all-cause mortality and recurrence rate at two years compared to non-COPD/ILD-related pneumothorax. Higher proportion of COPD/ILD group was considered unfit for surgical pleurodesis. One-year recurrence rate was lower in asthma (8.3%) and bronchiectasis (0%) patients than other disease groups (15.8-33.3%).
CONCLUSIONS: Our study demonstrated heterogeneous clinical phenotypes among different lung diseases with poorer outcome in acute chest infection and COPD/ILD population. Differentiation between infective and non-infective, COPD/ILD-related and non-COPD/ILD-related SSP may enable more personalized management.
METHODS: A retrospective observational study was conducted on SSP patients in a Hong Kong hospital. Clinical outcome of pneumothorax secondary to different underlying lung diseases including persistent air leak (PAL), 2-year post-discharge pneumothorax recurrence and all-cause mortality were evaluated. Logistic regression and cox regression analysis were applied for covariates adjustment.
RESULTS: Of the 223 SSP patients enrolled, 32 (14.3%) had acute chest infection and 191 (85.7%) had chronic lung diseases. The acute chest infection group had higher risk of PAL >14 days (40.6% vs. 17.8%; P=0.003), longer hospitalization (24 vs. 13 days; P=0.001) and higher all-cause mortality rate (25.0% vs. 12.0%; P=0.049) than chronic disease group. Among those with chronic lung diseases, COPD/ILD-related pneumothorax led to higher PAL risk (>2 days: OR: 2.14, 95% CI: 1.01-4.54, P=0.046; >14 days: OR: 4.02, 95% CI: 1.49-10.88, P=0.006) and prolonged hospitalization (14 vs. 12 days; P=0.02) but similar post-discharge all-cause mortality and recurrence rate at two years compared to non-COPD/ILD-related pneumothorax. Higher proportion of COPD/ILD group was considered unfit for surgical pleurodesis. One-year recurrence rate was lower in asthma (8.3%) and bronchiectasis (0%) patients than other disease groups (15.8-33.3%).
CONCLUSIONS: Our study demonstrated heterogeneous clinical phenotypes among different lung diseases with poorer outcome in acute chest infection and COPD/ILD population. Differentiation between infective and non-infective, COPD/ILD-related and non-COPD/ILD-related SSP may enable more personalized management.