Our lungs are responsible for bringing oxygen into the bloodstream and removing carbon dioxide from our bodies. Each lung expands like a balloon when we inhale air, but what happens if the balloon cannot inflate?

That’s what is called a collapsed lung, a term that you might have heard before—it happens sometimes when there is trauma, such as a rib puncturing the lung—like what happened to UFC fighter Paul Felder in a recent match. But there are many reasons it can occur—ruptured air sacs, issues from underlying lung diseases like COPD and cystic fibrosis, even screaming too hard at a One Direction concert. What exactly makes a lung collapse? Introducing pneumothorax.

First some lung basics: Your lungs are located inside the chest wall. Each lung is divided into lobes which are similar to balloons filled with sponge-like tissue. The lobes are surrounded by the visceral pleura, membranes that separate your lungs from your chest wall. As you breathe in and out, the lungs slide against the parietal pleura – a plastic wrap-like membrane that covers the chest wall. However, if one of your “balloons” leaks, for example when COPD causes holes in the lung tissue, the air you inhale is going to travel through the leak and into space between your lungs and chest, called the pleural cavity. Similarly, if there is a hole in the parietal pleura (like a bullet through the chest wall, for example), that can cause air to enter the pleural cavity directly from the outside.

“Because that air has nowhere to go, it keeps accumulating inside this space and builds up pressure between the chest wall and the lungs.  As the pressure and amount of air in this cavity increase it compresses your lung further and further, making it unable to expand when you breathe. That is a pneumothorax.” says Dr. Rutland, pulmonary and critical care physician and American Lung Association volunteer spokesperson. Pneumothorax is the medical term most people associate with a lung collapse but actually means “air in the pleura space causing your lungs to collapse or be compressed.” The pressure from the air keeps your lungs from being able to fully expand.

The term “collapsed lung” is often used in everyday speech as being the same as a pneumothorax.  However, a lung can collapse in two general ways—pressure from “outside” the lung as in pneumothorax described above or from lack of flow “into” the lung because the bronchial tubes or “pipes” are blocked by mucus, a polyp or a tumor. This type of collapsed lung is medically termed an atelectatic lung or atelectasis and is treated differently.

What are the symptoms of a pneumothorax

Symptoms of pneumothorax include shortness of breath, chest pain on one side, and experiencing pain when breathing. If you suspect you have pneumothorax, go to the emergency room right away. A chest X-ray will confirm this.

How is a pneumothorax treated?

Depending on the cause and the size of the leak, the lung can often heal itself, but in order to do so, the extra air in the pleura space needs to be removed to reduce the pressure so the lung can re-expand. If the size of the pneumothorax is large and creating significant distress, an emergency procedure includes the doctor placing a needle in the chest to remove the pressure quickly. This is then followed by placing a tube in the chest that is kept in place for a day or two until the leak is healed and closed and the lung is re-expanded.” 

This hollow tube is inserted between the ribs and is attached to a suction device to remove the air in the pleura space.5 Once this chest tube is inserted, it typically takes about 48 hours or so for the lung to heal.

Dr. Rutland says a simple test is performed to tell if the lung has healed. First, the chest tube is hooked up to a chamber system with water. Then the patient is instructed to cough. If air is escaping from the lung into the tube, bubbles will appear in the water chamber. “Once there are no more bubbles rushing through when I tell my patients to cough, then I know that the lung is healed, and I can take the tube out.”

How can I prevent pneumothorax?

While most cases cannot be prevented, discontinuing the use of tobacco products can reduce your risk of lung disease associated with pneumothorax. While males are generally more likely to experience pneumothorax, your genetics can also predispose you to certain types.

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