Q: I am a 24-year-old man. I am 1.68m tall and weigh 65kg. I am a non-smoker who leads an active lifestyle - I run and play football.
I had primary spontaneous pneumothorax for the first time in October in my right lung. It happened a second time in the same lung in December.
I went through a procedure called Vats for my right lung.
I would like to know is there I could do anything to strengthen the lungs to prevent a relapse in my right lung and a collapse of my left lung in future.
A: In traditional Chinese medicine (TCM), pneumothorax (collapsed lung) is likely due to the deficiency in the function of the lungs, spleen, liver and kidneys.
In TCM, good circulation of qi (energy) and blood is required in the body for good health.
The lungs control the respiratory system.
When qi in the lungs is weak - due to weak constitution or chronic diseases - it will be vulnerable to external pathogenic (disease-causing) factors, such as "heat", "dryness", "wind", "cold" and "dampness".
The spleen converts nutrients from food into qi and blood.
When the spleen is dysfunctional - due to an imbalanced diet, alcohol consumption and smoking - it will convert the nutrients into phlegm and "dampness", blocking qi in the lungs.
When external pathogenic factors invade the lungs, these factors, together with the internal phlegm and "dampness", can damage the pleura (membrane) of the lungs and trigger pneumothorax with chest pain, breathlessness, cough and a dry mouth.
The liver is responsible for the smooth flow of qi in the body.
Emotional upheaval, stress, tension and tiredness can cause qi in the liver to stagnate and interrupt the flow of qi in the lungs. This will trigger pneumothorax with sudden pain in the chest and ribs, breathlessness, dry cough and depression.
Normal respiration depends on mutual regulation by the lungs and the kidneys.
When qi in the lungs is weak, they will fail to coordinate with the kidneys, triggering pneumothorax with sudden chest pain after vigorous exercise, breathlessness, cough and poor appetite.
Chinese medicine, acupuncture, moxibustion, cupping and tuina (TCM massage) can improve your condition by strengthening your organs and dispelling the pathogenic factors.
Moxibustion involves burning a small herb above acupuncture points to help healing.
Cupping involves using fire and cups to create a vacuum on the skin to enhance blood and qi circulation.
Chinese medicine such as baical skullcap root, white mulberry root-bark, platycodon root, common coltsfoot flower, thunberg fritillary bulb, bitter apricot seed and heartleaf houttuynia herb strengthen the lungs, and dispel "heat" and phlegm in the lungs.
Milkvetch root, medicinal changium root, thinleaf milkwort root, common bletilla tuber and Indian bread increase the amount of qi in the lungs and strengthen the spleen.
Chinese thorowax root, red peony root, turmeric root-tuber, nutgrass galingale rhizome and orange fruit strengthen the liver and enhance qi circulation.
Processed rehmannia root, white peony root, common yam rhizome, Sichuan lovage rhizome, Chinese angelica and cassia bark strengthen the kidneys and increase the amount of blood.
Pinellia tuber, long-stamen onion bulb and snakegourd fruit enhance qi circulation and dispel phlegm.
Take easily digested food and drinks, such as porridge, fish, soup, honey, pear juice, fresh milk, lotus seeds, almonds and walnuts, to enhance nutrition and strengthen your lungs and digestive system.
Avoid heavy meals, and raw, cold, oily and spicy food to strengthen your digestive system and reduce the amount of phlegm.
Clear your bowels daily and avoid straining when doing so.
Sleep early, preferably by 10pm, and have sufficient rest to enhance your immune system.
You should also keep warm to prevent any infection in respiratory system.
Avoid becoming tired, stressed, angry and anxious, which will weaken the circulation of qi.
You should also avoid vigorous activities such as running and football, and replace them with light exercises such as brisk walking, taiji and yoga to improve your immune system and lung capacity.
Ms Lim Lay Beng,
traditional Chinese medicine practitioner at YS Healthcare TCM Clinic
No medication to decrease rate of recurrence
A: Pneumothorax - often called "collapsed lung" by the layman - is a medical condition where air leaks from a lung into the pleural cavity.
The pleural cavity is the space that lies between the visceral pleura and the parietal pleura - two layers of membrane which line and surround each lung.
When pneumothorax occurs, air leaks into this space, causing the lung to be compressed, resulting in symptoms such as chest pain and shortness of breath.
If left untreated, this progresses to respiratory failure and death, although this is a rare occurence in modern times.
Pneumothorax can result because of many reasons, including lung cancer, pneumonia, trauma to the chest (such as a stab wound) or because the lungs are damaged by cigarette smoke (a condition called chronic obstructive pulmonary disease or COPD).
Notably, Christopher Schwarzenegger, son of the former governor of California and actor Arnold Schwarzenegger, developed pneumothorax during an accident in 2011.
If there is no obvious cause, the condition is called primary spontaneous pneumothorax.
This condition usually occurs in young males (between the ages of 15 and 30), who are lanky in physique.
For some unknown reasons, many patients with primary spontaneous pneumothorax have been found to have little bubbles, called blebs, on the surface of the lungs.
It is thought that rupture of one of these blebs results in the pneumothorax.
Sometimes, these blebs occur on both of a patient's lungs, explaining the possibility that pneumothorax on one lung may recur in either the same lung or the other one.
Treatment of primary spontaneous pneumothorax depends on severity. Severity is usually assessed by the doctor who uses the chest X-ray as a guide.
If the condition is mild, the patient can be managed conservatively with just rest and oxygen. Oxygen speeds up the recovery of the pneumothorax and absorption of the air trapped between the affected lung and the chest wall.
If the pneumothorax is more severe, then procedures to suck out the air need to be performed. This can be in the form of inserting either a tube, or a needle and syringe, through the chest wall to suck it out. Either way, this usually results in the air being removed from the space.
If the leak is big, then a surgical procedure called video assisted thoracic surgery (Vats) needs to be performed. This procedure, done under general anaesthesia, involves inserting a rigid tube with a camera at the tip through the chest wall. The camera allows the surgeon to locate the blebs and these can then be clipped, ligated, stapled or burnt off.
The recurrence rate of primary spontaneous pneumothorax varies from 20 to 40 per cent. Once Vats is done, recurrence is very rare (less than 5 per cent).
To date, no medication has been shown to decrease the rate of recurrence.
Activities that cause a huge change in pressure, such as bungee jumping or diving, may result in recurrence of pneumothorax.
Dr Philip Eng,
senior consultant respiratory physician at Philip Eng Respiratory & Medical Clinic at Mount Elizabeth Hospital and adjunct associate professor of medicine at National University of Singapore
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