Which type of pneumothorax occurs in patients with COPD, pneumonia, cystic fibrosis or asthma?

• A. Primary spontaneous pneumothorax
• B. Secondary pneumothorax
• C. Iatrogenic pneumothorax
• D. Tension pneumothorax

Answer: (B)

Secondary spontaneous pneumothorax is the type that occurs in people with underlying lung disease such as COPD, pneumonia, cystic fibrosis, or asthma. In these conditions the lung tissue is often scarred or contains fragile blebs or bullae, so a small air leak from ruptured tissue allows air to enter the pleural space and collapse part of the lung. This differs from primary spontaneous pneumothorax, which happens in people without known lung disease due to rupture of apical blebs, iatrogenic pneumothorax from medical procedures, and tension pneumothorax, which is a dangerous accumulation of air that compresses the mediastinum and can occur with any type but isn’t defined by the presence of lung disease. Hence, the lung disease context points to a secondary spontaneous pneumothorax.