New research has found that deaths linked to spontaneous pneumothorax had been steadily falling in England for more than 15 years, but this progress was disrupted during the COVID‑19 pandemic.
Spontaneous pneumothorax is the development of a tiny tear in the outer part of the lung. This causes air to leak into the space between the lung and chest wall. It is called ‘spontaneous’ because it develops in the absence of trauma or medical procedure.
Researchers from the University of Oxford’s Nuffield Department of Population Health (NDPH) analysed almost two decades of data from national hospital and death records, covering more than 6,400 deaths where pneumothorax was mentioned on the death certificate. Most of these deaths occurred in hospital, and more than 80% involved people who had an underlying chronic lung disease.
This research, published in Lancet Regional Health Europe, was supported by the NIHR Oxford Biomedical Research Centre and by Health Data Research UK.
Between 2004 and 2019, the death rate from pneumothorax fell each year. But this trend was reversed in 2020, with deaths peaking in 2021. This spike can largely be attributed to COVID‑19, which can cause severe lung damage and make pneumothorax more likely.
When COVID‑related deaths were removed, pneumothorax mortality looked similar to pre‑pandemic levels.
The study also found that pneumothorax often plays a bigger role in deaths than official statistics suggest. In recent years, it was listed as the main cause of death in fewer than one in 10 cases where it appeared on the death certificate, but it contributed directly to the chain of events leading to death in nearly two‑thirds of cases.
Xiaomin Zhong, Health Data Epidemiologist at the NDPH and lead author on the paper, said: “Deaths from pneumothorax were falling until 2019 – a decrease consistent with improvements in respiratory care and service delivery. However, the COVID-19 pandemic highlights how external factors can disrupt positive trends.
“This study also analysed the impact of factors such as age and pre-existing conditions on mortality trends. We found that elderly patients with chronic lung disease were at highest risk, underscoring the need to closely manage this vulnerable population.”
The senior author, Dr Rob Hallifax, Respiratory Consultant at Oxford University Hospital NHS Foundation Trust, added: “These findings highlight that pneumothorax is not necessarily a benign condition and can be life‑threatening, especially for older people and those living with lung disease. We hope that this study might raise awareness and lead to improved care and help patients understand the risks.”