Manabendra Biswas, Kamrul Alam, Zillur Rahman, Bar Choudhury G M Akbar, Akm Razzak, Shafiqul Ahsan, Nabi Alam Khan.
Spontaneous pneumothorax secondary to COPD.
Professional Med J Jan ;14(2):255-62.

The high recurrence rate of spontaneous pneumothorax secondary to COPD highlights the need for the prevention of recurrence with cheap and cost effective method. Chemical pleurodesis with tetracycline hydrochlorides may be a good option for the prevention of recurrence of pneumothorax and thereby enables satisfactory patient outcome. Objectives: (i) To compare the recurrence rate of spontaneous pneumothorax treated with chemical pleurodesis with tetracycline hydrochloride and tube thoracostomy alone. (ii) To make a standard protocol for management. Study design: A prospective randomized case control study. Setting: The dept. of thoracic surgery of the National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka, Bangladesh. Period: From January 2003 to December 2003. Material & Methods: Sixty patients with spontaneous pneumothorax, secondary to COPD. After randomization, 30 patients were treated with tube thoracostomy followed by pleurodesis with tetracycline hydrochloride and another 30 patients of control group were treated with tube thoracostomy alone. Results: Patients were followed up upto 6 months and were looked for recurrence. Patients with spontaneous pneumothorax were of 4 to 6 decades of life and most of them were male. Most patients presented with moderate size of pneumothorax th th and required 91-110 hours for lung expansion after tube thoracostomy. Recurrence rate of spontaneous pneumothorax secondary to COPD in the tetracycline group was 3.3%, whereas in control group it was 30%. Intrapleural instillation of tetracycline hydrochloride significantly reduces the recurrence of spontaneous pneumothorax secondary to COPD. (P=0.015). Morbidity related to tetracycline was negligible. Moreover, tetracycline is cheap, easily available, non-toxic, well tolerated. Conclusion: It is concluded that recurrence rate of spontaneous pneumothorax secondary to COPD can be reduced effectively by chemical pleurodesis with tetracycline hydrochloride without any significant morbidity related to tetracycline hydrochloride and it is also very cost effective.

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