Collapsed lung prognosis without treatment?

September 17, 2009 6:34 PM

Can one live with a collapsed lung?

So two times in the past decade my lungs have collapsed. Spontaneous Pneumothorax. The first time I thought I was developing an allergy and just having a severe reaction, the second time I recognized the sensation and went straight to the ER after only a little hoping it was just stress.

The first time I had chest tubes for weeks on a vacuum until it healed, the second time I had to have a surgical pleurodesis and no problems since.

I often wonder, though...

What would have happened if I had not done anything either time? The pain is unbelievable, and the sensation of not being able to inhale fully is the stuff of nightmares, so I couldn't imagine it, but would I have died? Just been incapacitated? What would have happened to someone in 1850 who had one? Would I have just been an invalid?

In my case, it was only one lung, so I had partial function in the other.

I have been curious about it for years now, but all of the medical information is about how to treat it and get it taken care of, not what happens if you don't.

posted by Tchad to health & fitness (13 answers total)

well, i don't know what happens if you just leave it alone forever, but -

my dad's lung collapsed in the early 80s when he was overseas with the armed forces. he originally thought it was gas and walked the mile from class to the barracks, stopping for ice cream. he then realized it probably wasn't gas, but just in case it was he walked the mile back to the hospital. by the time he got to the hospital he could barely talk, he was shaking, sweating, and nearly passed out. they kept insisting that if you walk in you have to fill out paperwork, but he was physically unable to. i don't even want to think about what would have happened if he waited until the next day.
posted by nadawi at 6:43 PM on September 17, 2009 [1 favorite]

The big fear is that your run-of-the-mill pneumothorax might ultimately progress to a tension pneumothorax. This is essentially a scenario where the abnormal communaction between the airways and the pleural space around the lung which lead to the pneumothorax becomes a one-way valve through which air can only enter but not leave the pleural space. As air continues to accumulate there, it may not only collapse the lung, but also shift the contents of your mediastinum (the stuff in between the lungs in the middle of your chest like your heart and major vessels). Eventually this would lead to compression/kinking of your vena cavae, which would prevent blood from returning to your heart, rapidly dropping your arterial blood pressure and killing you as a result.
posted by drpynchon at 6:50 PM on September 17, 2009 [1 favorite]

You could have ended up with a pneumonia, pulmonary edema, heart failure. Chronically short of breath? I'm not completely sure. There's certainly a cohort of patients who walk around with one lung (pneumonectomy) and usually the other lung over-expands and the remaining area fills up with fluid. And certainly a cohort of patients who have a pleural effusion that essentially causes a completely nonfunctioning lung, which causes low oxygen levels as well.
posted by gramcracker at 6:51 PM on September 17, 2009

In many cases of a spontaneous pneumothorax, if the extent of the lung collapse is not too large, they don't intervene at all, they just tell you to rest for a few days and let it fix itself - and it does. The ruptured bleb heals, the air trapped in the pluera diffuses through the skin and out of the body, and pretty soon you're good as new.

But they'll prefer you be in the hospital while this happens, or otherwise under observation in case things don't get better and intervention proves necessary.

So in 1850, either you're good as new in a few days, or... you're not. Toss of the dice.
posted by -harlequin- at 7:03 PM on September 17, 2009

Two personal anecdotal stories that may or may not be enlightening to you.

Story the first:

When I was in college I shared this absolute armpit of a rental house with my friend Rob, who tended to be a tiny bit of a hypochondriac at times. I worked a 9-5 at an ad agency, and went to school on nights and weekends. Rob did the typical collegiate trick of scheduling his work around school, so he was home a lot during the day.

One day, I come home and start mowing the lawn. I am about half done, when Rob comes out of the house....cigarette in one hand, champagne of beers in the other. He smokes for a bit, then strikes up conversation.

"So I was supposed to go to work this morning, but I called in sick. I think I punctured a lung."

"Punctured your lung? Go on."

"Well, I was getting in my car to go to work, and when I bent over, I felt this sorta crinkly feeling." Rob takes another drag off his cigarette, and exhales slowly.

I eyeball the nonchalance in Rob's demeanor, and the cigarette in his hand. "I think maybe that if you punctured a lung, you would know it. And you'd probably be in pain or short of breath or something."

We banter about the lung for a bit, and Rob gets in the car to go to the hospital. Half an hour later, he returns and strikes up another cigarette, and grabs another beer out of the fridge.

"Not punctured, after all?" I ask him.

"Eh... I didn't make it to the hospital. I passed the BBQ joint on the way, and decided I wanted some BBQ."

Half an hour later, Rob leaves again. I don't see him until 3:30 in the morning. Dude had a punctured lung the whole time.

Moral of that story? Apparently, you can walk around pretty normally with a punctured lung...even smoke cigarettes.





Story the second:

Regarding being able to live with reduced lung volume and/or one lung... Due to a botched surgery when I was a toddler, I have a stunted and fused rib cage. You probably wouldn't notice it to look at me unless I pointed it out -- I just look thin -- but the net result is that I have about 18% of the lung capacity of a normal individual.

I get short of breath very easily if I exert myself, and in a race to save my life...well... the proverbial bear would eat me, for sure. That said, I get by quite well. 18% sounds like it would be maddeningly limiting, but you would be surprised at just how sedentary the American lifestyle really is at times.

I do get insanely jealous of joggers, though.
posted by kaseijin at 7:10 PM on September 17, 2009 [7 favorites]

My first spontaneous pneumo I walked around with for about 10 days, just thought i pulled a muscle in my back. The pain eventually drove me in to the hospital, but as long as it doesn't go tension or you don't get a secondary infection or something like that I imagine you can walk around like that and perhaps the bleb will heal up and eventually your body will re-absorb the air in your chest cavity.

If I knew how painful pleurodesis and the subsequent years of recovery from that and the VAT's would be I probably would have rather had another chest tube And every time they put one of those fuckers in I question my sanity for allowing someone to do it.

I have to be honest, I've wondered the same thing for years. For me I was ok from a functioning and dealing with the pain perspective as long as I wasn't trying to hold a conversation or walk up stairs or do much of anything really at all. As long as you still have enough spare capacity I think you could probably get by.
posted by iamabot at 7:25 PM on September 17, 2009

About 7 or 8 years ago I punctured a lung in a bicycle accident. I had the tube hanging out of my upper left side to drain the lung. Felt like a garden hose full of water pulling on me weight wise. I can relate to a lot of what has been said. I was very winded whenever I tried to do anything. And that wasn't too often. Mostly I was lying in a hospital bed. My breathing got better over a few days though. But I think you'd be alright (kaseijin) just not be 100%. Tiring easily ( nadawi's Dad), lots of huffing and puffing, just plain out of breath, etc., etc. I'm sure the other lung would strengthen itself over time making breathing better. The doctor wouldn't let me leave the hospital until I could take a good hard deep breath though, without the garden hose.

So if t happened to you in 1850, my guess is that you'd just be less able to do everything that required increased breathing.
posted by Taurid at 7:43 PM on September 17, 2009

So in 1850, either you're good as new in a few days, or... you're not. Toss of the dice.

About 6 years ago I was on my way to work downtown and, because freshly fallen snow makes me act like an idiot, I took a nasty spill on a patch of ice, went airborne for a few seconds and landed on my back hard. I got back up and made my way to the subway and down to the office in excruciating pain, assuming like iamabot that I'd badly pulled some muscles in my back.

Three hours later, over my objections, my boss made one of my coworkers take me up to Saint Vincent's where we found out I had three cracked ribs and a partially collapsed right lung. I was x-rayed, given some prescription strength Advil and observed for several hours before being x-rayed again. After declining to have my chest "wrapped", I was issued a prescription for some codeine-dosed painkillers and sent on my way, with instructions to rest for a few days while my lung healed and reinflated.

Just breathing hurt. Laughing was brutal and coughing was torturous. The one time I sneezed I came very close to blacking out from the pain. I don't know how much of that I can attribute to my lung and how much to my ribs, but I'd estimate that it took about a week or so before the pain subsided to a bearable level without meds.
posted by JaredSeth at 8:01 PM on September 17, 2009

You can definitely survive. I've had a minor collapsed lung. Since mine wasn't too bad, the treatment was to just keep to bed for about a week, and let it heal itself. That's what I did, and it did indeed get better.

So, at least with minor collapsed lungs, you can definitely survive.
posted by kingjoeshmoe at 8:02 PM on September 17, 2009

iirc, an early treatment for TB was to collapse the lung to seal in the area of infection.
posted by Billegible at 8:24 PM on September 17, 2009

My left lung has sponatneously collapsed twice.

The first time was minor. The doctor at the hospital, who happened to be a neighbour, told me that it would heal on its own if I stayed in bed for a while, but that he had a couple of interns around who wanted to try an old technique to fix it right away, and would that be okay? I said sure. They took out an absolutely gigantic syringe, marked a spot between my ribs, stabbed me with the syringe, and removed the air that had collected between my lung and the lung wall in order to re-inflate the lung. So, that may be what would have happened in 1850, had there been a giant syringe around and someone with good aim.

The second time was major. You see, they had told me after the first time that I should expect a recurrence, within a year. And a year later, I felt the symptoms and went immediately to the emergency room of a hospital. The on-call doctor, who looked very tired and annoyed, told me after the x-ray that it was nothing and that I probably just had gas. He did so in such a way as to make me feel like a complete idiot and a hypochondriac. So, when, 6 months later I started to feel the symptoms again, I ignored it, thinking "oh it's just gas or a cramp of some kind". So, I spent the whole day just dealing. That evening I drove a few friends to a concert in a city about 2 hours away. Watched the whole concert. In pain. Then after the show drove a friend-of-a-friend-of-a-friend to pick up his car because it had been towed, then, at about 1am finally set off back home. When I got back, I was in so much pain that I had to lower myself extraordinarily slowly onto my bed. I thought "yeah I'll just sleep it off". Then I remembered that I had a lecture the next morning, so I tried to roll over to set the alarm... and that was simply not possible due to the pain. So I went to the hospital.

I had a chest tube. And it hurt. In fact, the nurses and doctors informed that, most likely, this would be the most painful thing I would ever experience. So far, they have been right. General anaesthetic is not recommended, and no topical anaesthetic can really do the trick, so they basically have to cut you open between the ribs and you feel it all. I sat in the hospital for maybe a week with a vaccuum attached to a hole between my ribs, and copious amounts of demerol shot into my ass to ease the pain. Anyway, the guy who pushed my wheelchair around the hospital was this big old guy with a puffy handlebar moustache. He looked like one of these teddy-bear biker type dudes. He empathised with my situation because he too once had a collapsed lung, back when he was a lumberjack in northern British Columbia. Not from a fall or anything, but just for no reason. Like me, he had been a tall young skinny guy. Said he was bedridden for months and that it hurt and that it was terrible. Now, I gathered from his story that there wasn't a well-equipped hospital anywhere nearby... so while northern BC in the 1950s or 1960s may not be the same as say, medeival times, I assume that with a lot of collapsed lungs, they just heal on their own with plenty of rest.
posted by molecicco at 3:14 AM on September 18, 2009 [1 favorite]

My first spontaneous pneumothorax was severe, like someone shot me in the chest. Being young and dumb, I didn't go to the hospital for about a 7-10 days. It got a little better, but I could feel the air plopping around in there. I didn't know it was air though. I thought it was muscle and stuff. As drpynchon said, I think the fear is that it will turn into the tension variety and mess up your heart function. But if it doesn't do that, it seems like you could live a long time with it.
posted by milarepa at 5:18 AM on September 18, 2009

My dad lived with a collapsed lung for years. Lots of breathing issues, obviously, but it's hard to attribute a myriad of his other symptoms to the lung itself since he also had congestive heart failure, enlarged heart, and diabetes. He lived in our apartment relatively normally, aside from it being tiring to get around and having pain issues he took medication for. No machines hooked up to him, no medical assistance, etc.

So I don't think you'd have been an invalid or died, although it would still suck.
posted by Nattie at 1:24 PM on September 18, 2009