“Game-changer” for collapsed lung treatment

Congratulations to Professor Diana Egerton-Warburton and Professor Julian Smith for their collaboration with researchers from Australia and New Zealand on a landmark study to assess the appropriate level of management for treating spontaneous pneumothorax – also known as a collapsed lung.

Professor Egerton‐Warburton, Director of Emergency Medicine Research at Monash Medical Centre and Co‐Chair of Monash University’s Emergency Research Collaborative (MERC), and Professor Smith, Head of the Department of Cardiothoracic Surgery at Monash Health among other appointments with Monash University, co‐authored the study which found that interventional treatment is not necessarily the best course of action and that a ‘hands off’ approach often delivers better outcomes for patients.

Each year, approximately 3,000 Australians present at hospital emergency departments suffering from a collapsed lung. The condition can be caused by an underlying lung disease but more commonly for no obvious reason. It occurs when a spontaneous leak from the surface of the lung causes air to collect inside the chest, which in turn causes severe pain and breathing difficulties.

Up until now, the standard hospital treatment for a pneumothorax has been ‘interventional’, with doctors inserting a plastic tube into the patient’s chest to drain the collected air to help the lung reinflate. This treatment is often painful, and can also lead to organ injury, bleeding, infection and sometimes additional surgery if the air leak continues.

The six year study, which involved more than 300 patients in Australia and New Zealand, has shown that this traditional ‘interventional’ approach to treating a collapsed lung results in significantly longer hospital stays and greater complications compared to a more hands‐off approach – treating patients with simple pain relief, observing them and then sending them home to await the lung’s natural re‐expansion and recovery.

“This is an international game‐changer and a great example of the ‘first do no harm’ methodology,” said Professor Egerton‐Warburton of the results which have been published in the New England Journal of Medicine (NEJM).

The research challenges prior assumptions that have been made about how to treat spontaneous pneumothorax and is expected to shift the thinking around how doctors worldwide manage the condition.

Professor Smith says, “The finding that interventional treatment in the form of a chest drain is not always required in patients with a primary spontaneous pneumothorax is welcomed by cardiothoracic surgeons as they are often called upon to manage complications of chest drain insertion.”

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