Secondary Spontaneous Pneumothorax Incidence in COPD, Emphysema

The incidence and prevalence of a first-ever spontaneous pneumothorax in patients with chronic obstructive pulmonary disease (COPD) and emphysema are increased significantly in men and in Black patients, according to research presented at the 2020 CHEST Annual Meeting, held virtually, October 18 to 21.

Researchers conducted the largest, most comprehensive study on the subject to date by using a large commercial database, which contains an aggregate of electronic health data from 27 health care systems in the United States. Recognizing that COPD and emphysema represent the most common causes of secondary spontaneous pneumothorax (SSP), investigators sought to determine the prevalence and incidence of SSP in individuals with emphysema and COPD in the United States, and to characterize risk factors for the condition.

A cohort of patients with COPD and emphysema was identified between April 2015 and April 2020, according to Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT). All patients who had experienced a first-ever spontaneous pneumothorax were identified from this cohort. The researchers calculated the 5-year prevalence and stratified the data for race and sex. In addition, researchers calculated the incidence of a first-ever SSP in patients with COPD and emphysema between 2019 and 2020. Individuals who had experienced a traumatic pneumothorax or other parenchymal lung disorder were excluded from the study because these conditions are known for their predisposition to develop SSP.

Of a total of 39,967,810 individuals who were active in the database within the specified time frame, 1,167,490 with either COPD or emphysema were identified. Study findings showed the prevalence of SSP among individuals with COPD or emphysema compared with control individuals (ie, those individuals without emphysema or COPD) to be 345 of 100,000 individuals vs 30 of 100,000 individuals, respectively (prevalence ratio [PR], 11.41; 95% CI, 11.01-11.83)

Further, the prevalence of SSP was significantly higher in Black patients compared with White patients (423/100,000 persons vs 344/100,000 persons, respectively; PR, 1.23; 95% CI, 1.12-1.36). Additionally, the prevalence of SSP was nearly twice as high in men compared with women (PR, 1.95; 95% CI, 1.82-2.08).

Between 2019 and 2020, the annual incidence of a first-ever SSP among individuals with COPD or emphysema was 0.05% (ie, 50 cases per 100,000 persons per year). The incidence of SSP was higher in Black patients compared with White patients (90/100,000 persons vs 46/100,000 persons, respectively). Likewise, the incidence was higher among men compared with women (69/100,000 persons vs 31/100,000 persons, respectively).

The investigators concluded that additional studies are warranted to explore why certain characteristics may increase the tendency to develop SSP in patients with COPD and emphysema. Individuals who may be at high risk for SSP should also be evaluated to see whether they are candidates for prophylactic chemical pleurodesis.


Adoor D, Albrektson K, Matta M. Epidemiology of secondary spontaneous pneumothorax among patients with COPD and emphysema: a national population-based study. Presented at: the CHEST Virtual Annual Meeting; October 18-21, 2020. Abstract 1681.

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