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Pneumothorax in patients with COPD and emphysema receiving home chronic non-invasive ventilation: is it the emphysema phenotype or ventilator setting?
  1. Joanne M Sloots1,2 and
  2. Marieke L Duiverman1,3
  1. 1Department of Pulmonary Diseases/Home Mechanical Ventilation, University Medical Centre Groningen, Groningen, The Netherlands
  2. 2Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
  3. 3Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
  1. Correspondence to Joanne M Sloots; j.sloots{at}mst.nl

Abstract

We describe three patients with chronic obstructive pulmonary disease (COPD) and emphysema who developed a pneumothorax while receiving chronic home non-invasive ventilation (NIV). These cases raise the question whether the high alveolar pressures given by NIV may have contributed to the development of their pneumothorax by barotrauma. Pneumothorax in patients with COPD receiving NIV is uncommon, the pressures in our patients with COPD who developed pneumothorax were not extremely high and time to development of pneumothorax was relatively long after the initiation of NIV. Further, in our patients, the CT scan showed paraseptal emphysema, a known risk factor for pneumothorax. This suggests that COPD/emphysema phenotype is probably a more important factor for indicating pneumothorax risk than ventilator settings. Better phenotyping of patients with COPD in whom benefits of NIV can be expected at minimal risk of serious side-effects is needed to inform our patients properly and bring the field of chronic NIV in COPD forward.

  • Pulmonary emphysema
  • Respiratory medicine
  • Mechanical ventilation
  • Pneumothorax

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Footnotes

  • Contributors JMS and MLD both contributed to the manuscript by drafting the manuscript and performing critical revision on the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.