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(Chest. 2006;129:1267-1273.)
© 2006 American College of Chest Physicians

Patient Perspectives on Management of Pneumothorax in Lymphangioleiomyomatosis*

Lisa R. Young, MD; Khalid F. Almoosa, MD, FCCP; Stacey Pollock-BarZiv, PhD; Meg Coutinho; Francis X. McCormack, MD, FCCP and Steven A. Sahn, MD, FCCP

* From the Department of Medicine (Drs. Young, Almoosa, and McCormack), Division of Pulmonary and Critical Care Medicine, University of Cincinnati, Cincinnati, OH; The University of Toronto (Dr. Pollock-BarZiv), Toronto, Canada; The LAM Foundation (Ms. Coutinho), Cincinnati, OH; and Department of Medicine (Dr. Sahn), Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC.

Correspondence to: Lisa Young, MD, University of Cincinnati, Division of Pulmonary and Critical Care, 231 Albert Sabin Way, 6053 Medical Sciences Building, Cincinnati, OH 45267-0564; e-mail: Lisa.Young{at}cchmc.org

Abstract

Study objectives: The American College of Chest Physicians Delphi Consensus Statement on management of spontaneous pneumothorax recommended pleurodesis after the first secondary spontaneous pneumothorax to prevent recurrence, and evaluation of patients’ perspectives regarding pneumothorax treatment was identified as a future research priority. Patients with lymphangioleiomyomatosis (LAM) are an ideal population for performing these studies, since pneumothorax occurs and recurs more commonly in LAM than in any other chronic pulmonary disorder.

Study design and participants: A 23-item questionnaire evaluating opinions of pneumothorax treatment was distributed to 615 patients in the LAM Foundation patient database, with a response rate of 52%.

Results: Of respondents, 69% (216 of 314 patients) reported a history of radiographically documented pneumothorax, and 181 patients (84%) reported at least one pleurodesis procedure. Neither a history of pneumothorax nor surgical management of pneumothorax affected reported oxygen use or perception of overall lung function, yet 41% thought that their pneumothorax had contributed to a decline in lung function. Few patients (12%) worried frequently about a pneumothorax developing, but one third made lifestyle modifications due to fear of pneumothorax. Extensive pain associated with chest tube placement and inadequate pain management throughout treatment for pneumothorax were frequent concerns. Only 25% of respondents thought that pleurodesis was appropriate for a first pneumothorax, while 60% favored pleurodesis for a second pneumothorax. Despite the apparent reluctance to undergo pleurodesis, most patients agreed that pleurodesis helps prevent pneumothorax recurrence. One third of patients believed that their physicians did not consider their preferences regarding pneumothorax management.

Conclusions: LAM patients and physicians may have different views about the significance of pneumothorax, in that most patients appear to favor a conservative initial approach to pneumothorax management. In conjunction with appropriate pain management, a better understanding of patients’ perspectives will facilitate cooperative decision making and may ultimately improve clinical outcomes in LAM related to pneumothorax.

Key Words: lymphangioleiomyomatosis • pleurodesis • pneumothorax • shared decision making • tube thoracostomy • tuberous sclerosis




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F. X. McCormack
Lymphangioleiomyomatosis: A Clinical Update
Chest, February 1, 2008; 133(2): 507 - 516.
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