SPONTANEOUS PNEUMOTHORAX SECONDARY TO COPD

EFFECTS OF CHEMICAL PLEURODESIS IN THE RECURRENCE

Abstract

Introduction: The high recurrence rate of spontaneous pneumothorax secondary to COPD highlights
the need for the prevention of recurrence with cheap and cost effective method. Chemical pleurodesis with tetracycline
hydrochlorides may be a good option for the prevention of recurrence of pneumothorax and thereby enables
satisfactory patient outcome. Objectives: (i) To compare the recurrence rate of spontaneous pneumothorax treated
with chemical pleurodesis with tetracycline hydrochloride and tube thoracostomy alone. (ii) To make a standard protocol
for management. Study design: A prospective randomized case control study. Setting: The dept. of thoracic surgery
of the National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka, Bangladesh. Period: From January
2003 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 tetracycline
hydrochloride and another 30 patients of control group were treated with tube thoracostomy alone. Results: Patients
were followed up upto 6 months and were looked for recurrence. Patients with spontaneous pneumothorax were of
4 to 6 decades of life and most of them were th th male. Most patients presented with moderate size of pneumothorax
and required 91-110 hours for lung expansion after tube thoracostomy. Recurrence rate of spontaneous pneumothorax
secondary to COPD in the tetracycline group was 3.3%, whereas in control group it was 30%. Intrapleural instillation
of 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 COPD
can be reduced effectively by chemical pleurodesis with tetracycline hydrochloride without any significant morbidity
related to tetracycline hydrochloride and it is also very cost effective.