The impact of smoking in primary spontaneous pneumothorax

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 138; no. 1; pp. 192 - 195
• Main Authors: Cheng, Yeung-Leung, MD, PhD, Huang, Tsai-Wang, MD, Lin, Chih-Kung, MD, Lee, Shih-Chun, MD, Tzao, Ching, MD, PhD, Chen, Jen-Chih, MD, Chang, Hung, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-07-2009; AATS/WTSA; Elsevier
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biopsy; Bronchiolitis - etiology; Bronchiolitis - pathology; Bronchoscopy; Cardiology. Vascular system; Cardiothoracic Surgery; Female; Humans; Lung - pathology; Male; Medical sciences; Pneumology; Pneumothorax - etiology; Pneumothorax - pathology; Pneumothorax - surgery; Recurrence; Respiratory system : syndromes and miscellaneous diseases; Smoking - adverse effects; Thoracic Surgery, Video-Assisted; Tobacco, tobacco smoking; Toxicology; Young Adult; 11; VATS; HRCT; video-assisted thoracoscopic surgery; high-resolution computed tomography; Pneumothorax; Effusion; Respiratory disease; Spontaneous; Primary; Tobacco smoking; Pleural disease; Anesthesia; Circulatory system; Cardiology
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2008.12.019

Background The crucial role of cigarette smoking in the development of pneumothorax is unclear because nonsmokers can also develop primary spontaneous pneumothorax. The purpose of this study was to clarify the pathophysiologic effects of cigarette smoking and its clinical correlations in primary spontaneous pneumothorax. Methods Included were 115 specimens of lung tissue from patients with primary spontaneous pneumothorax who underwent video-assisted thoracoscopic surgery from January 2001 to December 2002. We reviewed the clinical features of 56 smokers and 59 nonsmokers with an average follow-up of 67 months. The pathologic findings of resected lung specimens were analyzed retrospectively. Results There were no statistical differences in sex, age, body height, body weight, body mass index, or the presence of blebs/bullae on computed tomography scans of the lung or under thoracoscopy between the 2 groups. In the smoking group, patients had more extensive respiratory bronchiolitis ( P < .001), a high prevalence of tobacco pigmentation ( P < .001), and a higher recurrence rate without or after surgery than the nonsmoking group (57% vs 22%, P = .001 and 8.9% vs 1.7%, P = .02, respectively). Patients with extensive respiratory bronchiolitis had significantly higher nonoperative and postoperative recurrences than patients with nonextensive respiratory bronchiolitis ( P = .004 and P < .001, respectively). Conclusion Cigarette smoking is associated with the pathophysiologic consequences of extensive respiratory bronchiolitis, which had a significant impact on the recurrence rates of primary spontaneous pneumothorax.