Pneumothorax in neuromuscular disease associated with lung volume recruitment and mechanical insufflation ‐exsufflation

A 25 ‐year‐old male with Duchenne muscular dystrophy and a 73‐year‐old male with motor neurone disease both presented with chest pain and increasing dyspnoea following routine mechanical insufflation‐exsufflation or lung volume recruitment, on a background of long‐term non‐invasive ventilat ion. In each case, chest radiograph revealed a pneumothorax which resolved with intercostal catheter insertion and cessation of routine lung volume recruitment. This rare but serious complication highlights the need for careful risk/benefit analysis by clinicians prescribing these therapies. A 25 ‐year‐old male with Duchenne muscular dystrophy and a 73‐year‐old male with motor neurone disease both presented with chest pain and increasing dyspnoea following routine mechanical insufflation‐exsufflation or lung volume recruitment, on a background of long‐term non‐invasive ventilat ion. In each case, chest radiograph revealed a pneumothorax. In both cases the pneumothorax fully resolved following insertion of an intercostal catheter. There was no immediate recurrence and the patients were discharged home and ceased ongoing prophylactic respiratory therapy, although one person had recurrent pneumothoraces subsequently. This rare but serious complication highlights the need for careful risk/benefit analysis by clinicians prescribing these therapies.

Source: Respirology Case Reports - June 12, 2019 Category: Respiratory Medicine Authors: Luke Andrew McDonald, David John Berlowitz, Mark Erskine Howard, Linda Rautela, Caroline Chao, Nicole Sheers Tags: Invited Case Report Source Type: research