Sunday, 24 November 2013

Pleural disease – Pneumothorax – The Risk factors

The pleura is a thin tissue covered by a layer of cells (mesothelial cells) that surrounds the lungs and lines the inside of the chest wall.
A. Pneumothorax is defined as a condition of collection of air within the pleural cavity, from either the outside or from the lung of which affect the lung breathing.
B.2. Risk factors
1. Gender, age and Influence of height
The risk of primary spontaneous pneumothorax was found to be greatest among persons 25 to 34 years old of each sex and greater for men than women, although a gradient of risk with increasing height was found which seemed to explain much of the male predominance in this condition(15).
2. Smoking
In the study of a sample consisted of 15,204 persons domiciled in the same circumscribed area (County of Stockholm). The annual incidence of first spontaneous pneumothorax (SP) in the admission area is 6/100,000 for women and 18/100,000 for men, showed that showed that smoking increased the relative risk of contracting a first spontaneous pneumothorax approximately ninefold among women and 22-fold among men and that there is a striking, statistically significant (p less than 0.001) dose-response relationship between smoking and the occurrence of SP(16).
3. Genetics
Certain genetic mutation in the family may increase risk of pneumothorax
a. N1303K mutation on CFTR gene
Bilateral pneumothorax is rarely seen and is a predictor of poor prognosis. There is a report of a newborn presenting with bilateral pneumothorax whose diagnosis was cystic fibrosis with N1303K mutation on CFTR gene(17).
b. BHD gene
Germline mutations of the BHD gene are involved in some patients with multiple lung cysts and pneumothorax(18).
c. FLCN gene
There is a report of a novel in-frame deletion mutation in FLCN gene in a Korean family with recurrent primary spontaneous pneumothorax(19).
4. Respiratory distress (RD)
In the study to describe respiratory distress (RD) in full-term neonates hospitalized in the NICU and to determine risk factors in this population for pneumothorax, indicated that RD at term exposes the infant to high morbidity and pneumothorax, especially if born outside of a level III maternity unit and absence of labor.
5. A history of pneumothorax
People who has had one pneumothorax are at at increased risk of recurrent pneumothorax.
6. An illicit drug history
there is a report of a case of a 27-year-old man with an illicit drug history who presented with acute left-sided pleuritic chest pain and dyspnoea managed as for a spontaneous pneumothorax with aspiration and subsequent chest drain insertion following a chest radiograph(20).
6. Other risk factor
According to study, a history of smoking, the existence of comorbidities, previous surgery for ipsilateral spontaneous pneumothorax (ISP), and hand stitching increase the risk of postoperative recurrence of the diseases(21).
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