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What is a Pneumothorax?

Normal inflation of the lungs occurs in part due to the pleural layer around the lungs. An outer layer called the parietal pleura lines the inside of the chest cavity. A corresponding layer called the visceral pleura lines the outer wall of the lungs. Between these two pleural layers is a small amount of fluid to reduce friction as they move against each other. The very narrow gap between the pleural layers is a closed system under negative pressure. This means that as the chest wall lifts and expands it pulls the lung wall up and out with it, helping to expand lung volume on inhalation. A natural elastic recoil in the tissues of the lung means it easily deflates as the chest wall comes back down with each exhaled breath.

A Pneumothorax occurs then the negative pressure of the pleural space is breached, allowing gas (usually air) to enter the space between the pleural layers. Without the pull of the negative pressure the two pleural layers stop moving in unison and elastic recoil of the lung tissue causes it to collapse. The severity of the collapse depends on the size of the breach and the amount of air that enters the pleural space.

Active cycle of breathing exercises  and postural drainage exercises supervised by a specialist physiotherapistAbove: Active cycle of breathing exercises and postural drainage exercises supervised by a specialist physiotherapist

What causes a Pneumothorax?

There are numerous conditions and injuries that could cause a Pneumothorax but the most common are described as follows;

Spontaneous pneumothorax usually occurs in tall, young people where greater shearing forces on the upper lung tissues occur during movement. In most cases existing conditions create small pockets of air, called blebs or bullae, in the lung tissue. When these rupture under physical stress they release the air into the pleural space, potentially triggering a pneumothorax.

Tension pneumothorax describes any injury to the pleural layers, trachea or bronchial branches within the chest cavity. Any small lesion or puncture can potentially act as a one way valve, letting air through with each inhaled breath, then pressing closed with exhalation preventing air escape. Even a small wound can, with time, let in enough air to trigger a pneumothorax.

Pneumomediastinum occurs when high pressures within the lungs cause ruptures in the alveoli boarding the centre of the chest cavity (the mediastinum). Escaping air can pass into the central, upper chest moving into adjoining spaces throughout the chest cavity. In a minority of cases this will eventually lead to a pneumothorax.

Iatrogenic and Traumatic pneumothorax describe breaches of the pleural space as a result from external foreign objects. Iatrogenic pneumothorax specifically refers to accidental puncture wounds caused by medical or surgical procedures. This could result from misguided needles, tubes or scalpel incisions. Traumatic pneumothorax can occur from either puncture wounds from external objects, or blunt impacts that crack ribs causing internal lecerations.

What are the symptoms of a Pneumothorax?

Depending on the initial cause and subsequent severity of the pneumothorax, it may present with very different symptoms. Indeed mild cases may show no signs at all and only be detected whilst examining related conditions. For those cases severe enough typical symptoms may include;

  • Breathlessness, from reduced vital lung capacity.
  • Shallow breathing, possibly rapid to compensate for reduced volume.
  • Sharp stabbing pains when breathing.
  • Decreased chest expansion on the side of the pneumothorax.
  • Elevated heart rate to compensate decreased blood oxygenation.
  • Anxiety, decreased alertness, confusion.

When your doctor examines you with a stethoscope they will find that your normal breath sounds on the affected side of the pneumothorax will be very quiet or absent altogether.

How is a Pneumothorax Diagnosed?

A doctor can confirm a diagnosis of Pneumothorax following a detailed investigation of your symptoms, medical history and using specific tests to rule out other possible conditions. The use of auscultation with a stethoscope to listen to your breathing sounds is one of the best diagnostic tools for identifying a pneumothorax.

If you suspect you have Pneumothorax you should seek medical assistance immediately. Left untreated a severe Pneumothorax can cause a shift in the heart and aortic artery position. This can lead to abnormal pressures and a risk of heart failure.

Once diagnosed and stabilised we can assess your current level of lung function and target treatments accordingly. For more information on how physiotherapy can help treat a Pneumothorax, or to book yourself an assessment, please contact us via email at or ring us on 0330 088 7800.

What would a physiotherapy assessment for a Pneumothorax involve?

At, we want to gain as much information as possible about your condition to ensure we give you the best treatment. In your first appointment with us, our physiotherapists will carry out an assessment which has two parts:


A discussion between you and our physiotherapist to find out what symptoms you are experiencing, and how your condition is affecting you and your lifestyle.


An assessment to discern the presence of any pain, your current breathing pattern, respiration rate, lung volume and a series of special tests to identify the presence of any mucus retention and lung function impairment.

There can be great variation in the symptoms displayed, depending on the progression of the condition and any complicating factors. The assessment process will be important in identifying your current symptoms and needs, so that treatments can be targeted and effective.

What would physiotherapy treatment for a Pneumothorax involve?

Once the cause of the pneumothorax has been identified and addressed, with the trapped air reduced or removed altogether, then rehabilitative care can begin. At, our physiotherapists will ensure you specialised treatment for your Pneumothorax. Depending on the severity and duration of your condition, your treatment may involve:

  • Secretion clearance:
    • Effective / productive coughing techniques.
    • Postural drainage in sitting and lying.
    • Manual assistance, including percussion, vibrations and shaking.
  • Breathing technique retraining:
    • Controlling respiratory rate
    • Diaphragmatic breathing
    • Controlling / reducing breath volume
    • Relaxation breathing exercises
  • Education and Advice:
    • Illness cause and progression.
    • Effects of environmental and allergen factors.
    • Medication management

At you will experience a personalised treatment session. Each appointment will be aimed at returning to your everyday activities and what you enjoy.

How can I arrange a physiotherapy assessment for a Pneumothorax?

If you have been diagnosed by your doctor as having a Pneumothorax and are suffering from symptoms affecting your breathing and lung clearance, you would benefit from an assessment with one of our experienced respiratory physiotherapists.

You can contact us directly to arrange an assessment and we can advise you if further treatment is recommended, and give you advice on self-management. To arrange an appointment please email or call 0330 088 7800.


At, our respiratory physiotherapists can provide specialist assessment and treatment for people with Pneumothorax. We can apply a range of therapy techniques and advice to manage your symptoms and maintain the best possible level of lung function and comfort. We can also advise on activity modification to make daily living easier. Along with advice for you and your family on appropriate self-management techniques to maximise your functional ability between therapy sessions.

For more information on how physiotherapy can help treat Pneumothorax, or to book yourself an assessment, please contact us via email at or ring us on 0330 088 7800.

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