British Thoracic Society Guideline for pleural disease

Summary of recommendations and good practice points
Spontaneous pneumothorax
Acute management for spontaneous pneumothorax

Recommendations
Conservative management can be considered for the treatment of minimally symptomatic (ie, no significant pain or breathlessness and no physiological compromise) or asymptomatic primary spontaneous pneumothorax in adults regardless of size. (Conditional—by consensus)

Ambulatory management should be considered for the initial treatment of primary spontaneous pneumothorax (PSP) in adults with good support, and in centres with available expertise and follow-up facilities. (Conditional)

In patients not deemed suitable for conservative or ambulatory management, needle aspiration or tube drainage should be considered for the initial treatment of primary spontaneous pneumothorax in adults. (Conditional)

Chemical pleurodesis can be considered for the prevention of recurrent of secondary spontaneous pneumothorax (SSP) in adults (eg, patients with severe chronic obstructive pulmonary disease who significantly decompensated in the presence of a pneumothorax, even during/after the first episode). (Conditional)

Thoracic surgery can be considered for the treatment of pneumothorax in adults at initial presentation if recurrence prevention is deemed important (eg, patients presenting with tension pneumothorax, or those in high-risk occupations). (Conditional)