LISP - Longitudinal Investigation of Secondary Pneumothorax
Research type
Research Study
Full title
Longitudinal Investigation of Secondary Pneumothorax
IRAS ID
316472
Contact name
Steven Walker
Contact email
Sponsor organisation
Research and Innovation
Duration of Study in the UK
1 years, 6 months, 0 days
Research summary
Research Summary:
Secondary spontaneous pneumothorax (SSP) is a medical emergency where an abnormal collection of air develops in the space between the lung and the chest wall, causing lung collapse. This occurs in patients with existing lung disease such as Chronic obstructive pulmonary disease (COPD). In the UK, patients with SSP are usually treated by inserting a drain into the chest to remove the air. The drain is stitched in place and left until the air is completely removed. The drain typically remains in place for over a week, leading to long hospital stays. Sometimes these patients need surgery to help stop the air leaking into the lung, but many are not fit for major surgery.
We do not have data from UK patients about key consequences of developing a secondary spontaneous pneumothorax. We don’t know how long patients stay in hospital, how many have surgery, or how many develop complications. With this information we can better plan for care and help our patients make informed decisions, but also look at why some patients stay longer in hospital or need to have surgery. We have included feedback from patients in the design of this study; they told us that length of hospital stay was really important and also that they want treatments that aren’t painful.
We will recruit patients admitted to hospital with SSP across the UK over a 12-month period. We will collect routine data from their medical records, such as age, medical history, length of stay. All data will be collected as part of the patients’ routine care.
Results from this study will be written up in journals and presented at conferences and will help to decide how best to manage patients with SSP.Lay summary of study results:
A secondary spontaneous pneumothorax (SSP) is a collapsed lung that happens in people who already have underlying lung disease, such as COPD or pulmonary fibrosis. There is currently limited evidence to guide doctors on the best way to treat SSP or predict which patients are most at risk of poor outcomes.This study followed 213 patients with SSP treated at 20 NHS hospitals across the UK over a six-month period. Most patients were older adults, with an average age of 68 years, and around two-thirds were men.
Doctors treated most patients with a pleural procedure, usually inserting a chest drain to remove air from around the lung. However, just over a quarter of patients were initially managed conservatively, meaning they were closely monitored without an immediate procedure. Only a small number of these patients later required an intervention, suggesting that conservative management can be successful for selected patients.
Patients stayed in hospital for a median of 8 days, while the air leak itself usually resolved within 3 days. Around 1 in 5 patients died within six months of their SSP.
The study found that patients who were more frail, or who had recently experienced a worsening of their lung disease, tended to have longer hospital stays and poorer outcomes. Frailty was strongly linked to a higher risk of death within six months. Larger chest drains were also associated with slower recovery from the air leak.
This is the largest prospective UK study of SSP to date. The findings improve understanding of who develops SSP, how it is currently managed in the NHS, and which patients are at higher risk of complications or death.
REC name
South West - Frenchay Research Ethics Committee
REC reference
22/SW/0125
Date of REC Opinion
2 Dec 2022
REC opinion
Further Information Favourable Opinion