When I visited the surgical department of Tokyo University in 1996, my father went with me as my personal translator. During this visit, we had the time to discuss many medical topics including the relationship between doctor and patient, and some diseases in chest surgery. I was impressed that he translated a Japanese book about the management of spontaneous pneumothorax. When he suffered from cancer in early 1998, I recalled the time in Tokyo and decided to set up an association of friends of spontaneous pneumothorax . Through a web site, we can receive comments from patients, and give advice about solutions to their problems. We hope a complete care of this disease to achieve by a mutual understanding between physician and patient.

  From the comments, we noticed almost every patient didn’t know about this disease at the time of onset: ”I had never heard of this disease before I suffered from chest pain and was diagnosed after a chest X-ray.” Spontaneous pneumothorax is a condition where air leaks from the lungs without any evidence of trauma and the air accumulates in the pleural cavity. Spontaneous pneumothorax can be divided into two groups, primary spontaneous pneumpthorax, without any obvious lung disease, and secondary spontaneous pneumothorax, related to lung disease.

According to statistics, the incidence of spontaneous pneumothorax is 1 to 7 people per hundred thousand. People who are tall and thin, who smoke and who have a family history tend to suffer from spontaneous pneumothorax. Commonly the first symptoms are chest pain, shortness of breath and /or a cough. Generally the patient feels anxious, helpless and troubled. But, a definite diagnosis can be made only by a simple chest X-ray.

  The diagnosis is easy to make, but the declining patient-physician relationship and lack of mutual confidence cause difficulties. One comment from a patient’s family member revealed his suspicion.

:”On Jan. 1, 2000 my family member was sent to xx hospital in Chung-Li. At 3:50 PM a chest X-ray revealed pneumothorax, a disease I have never heard of before. When I arrived at the hospital from Yi-Lang at 8 PM, the operation had already been completed. I would like to ask you a question: the first is ‘did spontaneous pneumothorax have to be treated so quickly?’”. ”I would like to ask one question: why does almost every case result in operation or medication from the onset the disease?” ”Why, when a doctor sees my X-ray, does he/she always suggest an emergent operation due to the severity of my disease?” In general after his/her first attack , a patient will be treated by bed rest, observation and percutaneous aspiration if the symptoms are mild( not more than 20% pneumothorax deterioration ). Otherwise, one with more obvious symptoms, including an extended deterioration area of pneumothorax, contralateral lung disease or more than 20% pneumothorax, contralaterral lung disease or more than 20% pneumothorax should be treated with tube thoracostomy. Thoracotomy will be necessary if air leakage persists, if the lung collapes, if hemothorax develops or if tension pneumothorax exists.  If this attack is not first, the chance of recurrence will increase. So most surgeons will initially suggest thoracotomy in these cases.      

In the past, the standard surgical intervention for spontaneous pneumothorax was thoracotomy. But the large incision, postoperative pain and cosmetic damage made the physician and patient hesitate  to perform or receive thoracotomy. Now we can use 3 or 4 small incisions of 0.5 to 2 cm in length to do the same procedure with the assistance of a videocamera and an autosuture machine. With these modern procedures, the prompt postoperative recovery and little cosmetic damage help the physician and patient to make a quick decision for disease management.

  Furthermore, some thoracic surgeons will undertake surgical intervention even on patients whose attack was their first. Following management, the recovered patients still have a question: May I or can I live or exercise as before?  “Even with a full recovery I’m still afraid to do same exercise.” “ I used to do exercise but since the surgery, I seldom do it. So I don’t know how to live now.” According to our experience, most of the patients have the attack while resting. Thereforre exercise isn’t a contributing factor of the attack. So I encourage patients to return to their previous lifestyle. Patients should avoid vigorous exercise in the same way that the general population should because it can result in injury and it is not good for the health. The aim of the management of spontaneous pneumothorax is to help the patient live as normal. When the patient asks” I’m going to study abroad next summer. Is it OK to travel by plane?” In my opinion, everyone has the same risk while traveling by plane. And in fact many undiagnosed patients fly now.

 Patients live in constant fear of their next attack. “Following the operation, I haven’t been able to stop worrying. I’m afraid that my lung will rupture when I wake up in the morning. Because of the first attack, I had to quit school in my freshman year. The second attack made me fail the graduate entrance exam. I am hesitating to study abroad. I don’t know when the next attack will occur.” “I was always confident about the future. But worrying about the disease in recent years made a mess of my life. Sometimes I think I am too weak.” “Is the chance of recurrence after thoracoscopic surgery really going down? Does the surgery guarantee no chance of recurrence?” Traditional wedge resection of the lung lesion and pleurodesis can result a recurrence rate of only 1 to 2 %. This may be low but it is not perfect. However, is there anything in our life, that has a 100% guarantee?

  I’m a doctor with western medical training. But I learned the wisdom of complete health and “Heart” gong fu from my Shifu. From my patients, I can understand the need for improved psychological support. But psychology is the most difficult thing to understand within the limits of modern medical knowledge and undetectable personal feelings. We have tried to change this situation by setting up a web site where patients can learn to handle their feelings and illness by mutual experience exchange and encouragement. I thick it is the best and quickest way to face the problem.         

  In the web site, we call spontaneous pneumothorax a natural and positive disease. In a normal respiratory process the pressure of the pleural space is negative but it becomes positive when the air leaks into the pleural cavity, causing pneumothorax. Disease is a natural oart if life and we should look at spontaneous pneumothorax in that way. I sincerely hope every patient can, with a positive outlook , achieve a high quality of life.