Source: Annual Congress 2001 - Thoracoscopy

Abstract

Introduction: Pneumothorax (PT) is an important cause of morbidity in patients with chronic obstructive pulmonary disease (COPD). Following relief of PT with tube thoracostomy, pleurodiesis is usually performed to prevent a recurrence. We studied the effectiveness of medical thoracoscopy (MT) with talc poudrage in the management of PT in patients with COPD.
Material and Methods: Clinical records of patients with PT and COPD who had undergone MT were reviewed. The procedure was performed through a single point of entry, under local anaesthesia and light sedation in the endoscopy suite; up to 5g of sterile talc was insufflated for pleurodiesis. The intercostal tube was removed upon cessation of air-leak.
Results: 28 patients (26M:2F) with a mean age of 71.8±]7.5 years were treated. Mean FEV₁ was 45.6±]12.7% of predicted. In 9, PT was recurrent and pleurodiesis attempted before. After MT, 11 patients (39%) experienced pain, 4 (14%) had fever and 19 (68%) had subcutaneous emphysema of varying degree, which subsided without further intervention. The air-leak exceeded 7 days in 9; the interval to chest tube removal 7.2±]6.2 days. Two patients developed pneumonia during the hospitalisation. 2 patients (FEV₁30% & 40% predicted) died from severe exacerbation of COPD within 2 weeks of procedure. There was no recurrence at 12 months post-procedure.
Conclusion: MT with talc poudrage is a safe and effective method of pleurodiesis for patients with PT and impaired lung function from COPD.

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Citations should be made in the following way:
A. W. K. Ng, P. Lee (Singapore, Singapore). Medical thoracoscopy with talc poudrage for pneumothorax in patients with chronic obstructive pulmonary disease. Eur Respir J 2001; 16: Suppl. 31, 3480

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