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The initial British Thoracic Society (BTS) guidelines for the treatment of pneumothoraces were published in 1993.17 Later studies suggested that compliance with these guidelines was improving but remained suboptimal at only 20–40% among non-respiratory and A&E staff.

Clinical guidelines have been shown to improve clinical practice,18 19 compliance being related to the complexity of practical procedures20 and strengthened by the presence of an evidence base.21 The second version of the BTS guidelines was published in 200322 and reinforced the trend towards safer and less invasive management strategies, together with detailed advice on a range of associated issues and conditions.

This review explores the epidemiology and causes of pneumothorax and discusses diagnosis, evidence based management strategies, and possible future developments.

If uncertainty exists, then CT scanning is highly desirable (see below).

Added sounds such as ‘clicking’ can occasionally be audible at the cardiac apex.23 The presence of observable breathlessness has influenced subsequent management in previous guidelines.17 23 In association with these signs, cyanosis, sweating, severe tachypnoea, tachycardia and hypotension may indicate the presence of tension pneumothorax (see later section).

Arterial blood gas measurements are frequently abnormal in patients with pneumothorax, with the arterial oxygen tension (Pa This has been the mainstay of clinical management of primary and secondary pneumothorax for many years, although it is acknowledged to have limitations such as the difficulty in accurately quantifying pneumothorax size.

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Traumatic pneumothorax is not covered by this guideline.

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