The word ‘collapsed lung’ evokes associations with a blown tire. Pang. But is that image correct? What is a collapsed lung, and what can you do about it?
“Two membranes play a role in this story,” says pulmonologist Stephan Kops of the Radboud university medical center in Nijmegen. “The pleura, on the outside of the lungs, and the pleura, on the inside of the chest. The two lie close together, with a thin layer of fluid between them. When the chest expands, the lungs ‘stick’ to the chest due to vacuum action.”
This happens when you tense your breathing muscles. The lungs become larger, negative pressure is created and air flows in. Kops: “But if a hole is created in one of those membranes, air gets in between and the vacuum disappears. Just like with a suction cup where air gets underneath. The result is that the lung no longer sticks so well to the pleura and collapses.”
This happens completely silently. Many people only feel some pain or tightness; some people feel a sharp sting. “The lung often remains partly in place,” says Kops. “But it can also collapse completely, until it is slightly larger than a fist. The lung tissue is very soft and spongy.”
Car accident or stabbing
Some collapsed lungs develop spontaneously. Others have a clear cause: for example a car accident, a stab or a chronic lung disease such as COPD. This sometimes causes air bubbles to form in the lung tissue. “If they lie against the lining of the lungs, it becomes very vulnerable to pressure differences. For example, when you cough or sneeze,” says Kops. “Smoking and smoking cannabis also damage the lung tissue and thus increase the risk of a collapsed lung. There are also indications of this with vaping, but not enough to draw firm conclusions.”
What to do in case of a collapsed lung? Can you stick the membranes? “The lining of the lungs is a living tissue that repairs a hole automatically,” answers Kops. “The air between the membranes is absorbed by the body, and the lung gradually regains its former volume.” You can speed this up by extracting the air, but that is usually not necessary. Not even with a total collapsed lung: “One important study from 2020 showed that after eight weeks there is no difference between intervention and no intervention.”
Even in the event of a stab, doctors do not have to repair the membranes. “The surgeon sutures the wound in the chest and usually places a tube to let the air out. The rest heals on its own.” Urgent action is only required in the case of a so-called tension collapsed lung. “The wound then works like a valve: with each inhalation, more air comes in, but it can no longer get out. The heart and the other lung are compressed. The doctor then has to quickly place a tube.”
After eight weeks, about 90 percent have fully recovered. However, if you do not intervene, there is a chance of recurrence one in three. “With frequently recurring collapsed lungs, we can stick the membranes together a little,” says Kops. “For example, by introducing a liquid containing talcum powder between the membranes. This causes an inflammatory reaction and adhesion. Or the surgeon removes part of the pleural lining and then places the lung directly against the chest, after which it grows together.”
A serious intervention, notes Kops, but very effective: the chance of return drops almost to zero. The medical version of the anti-puncture tape.
