A randomised controlled trial of interventional versus conservative treatment of primary spontaneous pneumothorax

How does conservative and interventional management of collapsed lung compare?


Lay Summary

Primary spontaneous pneumothorax (PSP) is defined as a collapsed lung with air in the pleural cavity that occurs in the absence of clinically apparent underlying lung disease. PSP is a significant global health problem affecting adolescents and young adults. Throughout the 20th century the treatment of PSP was predominantly bed rest, with invasive treatment reserved for severely symptomatic episodes. A study in 1966 suggested that managing large and small PSP in the community was safe. Despite this, rates of intervention have steadily increased over the decades. The reasons for this are unclear and this approach has recently been questioned in the scientific literature. Preliminary data suggests that a conservative approach to management may allow faster healing and reduce the risk of recurrence from around 25 per cent to 5 per cent in the first year. Conservative management is also likely to reduce the risks of prolonged admission due to persistent leak from approximately 30 per cent to less than 10 per cent and of other complications related to interventional management. Clinicians are, however, unlikely to change a practice entrenched for decades and re-enforced by current international guidelines without robust evidence.

If allowing the lung to remain collapsed initially does improve healing of the pleural defect and lower recurrence rates, then this study will contribute to improved outcomes and a reduction in the morbidity associated with current treatment. This would mean a major change in current medical practice and international consensus guidelines. It would also be of substantial economic benefit due to reduced hospital admission rates on first presentation and also a reduction in the risk of subsequent recurrences, admissions and associated procedures.

Leveraged Funds

- $401,153.70 NHMRC Grant
- $50,000 In-Kind Support


Brown SGA, Ball EL, Perrin K, et al. Study protocol, for a randomised controlled trial of invasive versus conservative management of primary spontaneous pneumothorax. BMJ Open 2016;6:e011826. doi:10.1136/bmjopen-2016-11826


Amount Awarded


Grant Scheme


Principal Investigator:
Dr Frances Kinnear

Co Investigators:
A/Prof Kevin Chu
A/Prof Gerben Keijzers
A/Prof Mark Little
Dr Graham Simpson
Dr Jeremy Furyk
Prof Simon Brown

Associate Investigators:
Dr Duncan McAuley
Dr Deepak Doshi
Dr Greg Treston
Dr Joseph Ting
Dr Chris May
Dr Simon Tebbutt
Dr Yusuke Ueno-Dewhirst
Kylie Baker


Collaborating Institutions

CONTACT US +61 7 3720 5700 info@emfoundation.org.au Suite 1B, Terraces, 19 Lang Parade, Milton Qld 4064