A pneumothorax (noo-moe-THOR-aks) is a collapsed lung. A pneumothorax occurs when air leaks into the space between your lung and chest wall. This air pushes on the outside of your lung and makes it collapse. A pneumothorax can be a complete lung collapse or a collapse of only a portion of the lung.
A pneumothorax can be caused by a blunt or penetrating chest injury, certain medical procedures, or damage from underlying lung disease. Or it may occur for no obvious reason. Symptoms usually include sudden chest pain and shortness of breath. On some occasions, a collapsed lung can be a life-threatening event. Hospital admissions for pneumothorax as a primary diagnosis occurred at an overall incidence of 16.7/100,000 per year and 5.8/100,000 per year for men and women, respectively1.
1. Gupta D, Hansell A, Nichols T, et al. Epidemiology of pneumothorax in England. Thorax 2000;55(8):666. doi: 10.1136/thorax.55.8.666
What is the treatment?
Treatment for a pneumothorax usually involves inserting a needle or chest tube between the ribs to remove the excess air. However, a small pneumothorax may heal on its own.
What are the signs and symptoms of pneumothorax?
The main symptoms of a pneumothorax are sudden or gradual onset chest pain and shortness of breath. Severity of symptoms may depend on how much of the lung is collapsed. The symptoms may be mild to begin and develop over hours or days. Pain when breathing in can be a sign.
Who is most likely to suffer from pneumothorax?
In general, men are far more likely to have a pneumothorax than women are. The type of pneumothorax caused by ruptured air blisters is most likely to occur in people between 20 and 40 years old, especially if the person is very tall and underweight.
Underlying lung disease or mechanical ventilation can be a cause or a risk factor for a pneumothorax. Other risk factors include:
- Smoking. – the risk increases with the length of time and the number of cigarettes smoked, even without emphysema.
- Genetics – certain types of pneumothorax appear to run in families.
- Previous pneumothorax – anyone who has had one pneumothorax is at increased risk of another
What are the consequences?
Hospital treatment which may last several days but, with proper treatment, most people recover. Elderly and frail people may become more ill. Those with time dependent medical procedures planned may have to postpone.
How often does pneumothorax occur in acupuncture treatments?
In large prospective observational study, pneumothorax occurred twice in 2.2 million acupuncture sessions. One patient required hospital treatment the other observation only. No permanent harm was caused2.
2. Witt CM, Pach D, Brinkhaus B, et al. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forschende Komplementärmedizin 2009;16(2):91-97. doi: 10.1159/000209315
Why can it happen in acupuncture?
As pneumothorax after acupuncture is very rare, there is no research that has examined the details of what went wrong. However, the following are likely to be relevant:
- Excessive depth of needling over the lung area
- Inappropriate direction of needling
- Excessive movement by the patient
How can it be prevented?
- Needling the correct depth and direction
- Using the correct length needle for the point
- The patient should not practice deep breathing exercises whilst having treatment
- The patient should remain still during treatment
- Needling on expiration not inspiration when over the lung area
- Be risk averse in high risk groups such as chronic lung disease and smokers
A pneumothorax after acupuncture is very rare. The training that BAcC practitioners receive means that the likelihood of such an event is minimised further. The British Acupuncture Council (BAcC) guarantees high standards of training, safe practice and professional conduct.
Look for the letters MBAcC after the name of your acupuncturist to be sure of:
- extensive training – minimum three years degree level – with relevant western medicine including anatomy and physiology
- adherence to the BAcC codes of safe practice and professional conduct
- compliance with current health and safety legislation
- full cover for medical malpractice and public/products liability
- mandatory continuing professional development to keep knowledge and skills up to date
The BAcC’s work as regulator is overseen by the Professional Standards Authority which provides an extra level of assurance to those seeking acupuncture.
1. Gupta D, Hansell A, Nichols T, et al. Epidemiology of pneumothorax in England. Thorax 2000;55(8):666. doi: 10.1136/thorax.55.8.666
2. Witt CM, Pach D, Brinkhaus B, et al. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forschende Komplementärmedizin 2009;16(2):91-97. doi: 10.1159/000209315
Ian Appleyard, Research & Policy Manager
Hannah Bowie-Carlin, Safe Practice Officer
September 2022
