SPONTANEOUS PNEUMOTHORAX SECONDARY TO COPD

Abstract

Introduction: The high recurrence rate of spontaneous pneumothorax secondary to COPD highlightsthe need for the prevention of recurrence with cheap and cost effective method. Chemical pleurodesis with tetracyclinehydrochlorides may be a good option for the prevention of recurrence of pneumothorax and thereby enablessatisfactory patient outcome. Objectives: (i) To compare the recurrence rate of spontaneous pneumothorax treatedwith chemical pleurodesis with tetracycline hydrochloride and tube thoracostomy alone. (ii) To make a standard protocolfor management. Study design: A prospective randomized case control study. Setting: The dept. of thoracic surgeryof the National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka, Bangladesh. Period: From January2003 to December 2003. Material & Methods: Sixty patients with spontaneous pneumothorax, secondary to COPD.After randomization, 30 patients were treated with tube thoracostomy followed by pleurodesis with tetracyclinehydrochloride and another 30 patients of control group were treated with tube thoracostomy alone. Results: Patientswere followed up upto 6 months and were looked for recurrence. Patients with spontaneous pneumothorax were of4 to 6 decades of life and most of them were th th male. Most patients presented with moderate size of pneumothoraxand required 91-110 hours for lung expansion after tube thoracostomy. Recurrence rate of spontaneous pneumothoraxsecondary to COPD in the tetracycline group was 3.3%, whereas in control group it was 30%. Intrapleural instillationof tetracycline hydrochloride significantly reduces the recurrence of spontaneous pneumothorax secondary to COPD.(P=0.015). Morbidity related to tetracycline was negligible. Moreover, tetracycline is cheap, easily available, non-toxic,well tolerated. Conclusion: It is concluded that recurrence rate of spontaneous pneumothorax secondary to COPDcan be reduced effectively by chemical pleurodesis with tetracycline hydrochloride without any significant morbidityrelated to tetracycline hydrochloride and it is also very cost effective.