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Treatment of Other Lung Conditions

Treatment of pneumothorax

A pneumothorax is a rupture of the air sacs, called alveoli, of the lung, allowing air to enter into the cavity that surrounds the lung. The air that enters the chest cavity puts pressure on the lung from the outside, squeezing the lung and making breathing more difficult. This unnatural pressure may also obstruct the flow of blood within the lungs and into the heart.

The size of the rupture will influence treatment. Sometimes, the air is removed with a needle and, if the pneumothorax is small, it may heal on its own. In most cases, a chest drain is inserted between the ribs to allow the continuous removal of the air from the cavity surrounding the lung. The chest drain is connected to an underwater chamber that is placed on continuous suction. It is possible to see bubbles of gas moving through the chest tube. When the pneumothorax has resolved, the chest drain will show fluctuations of fluid bubbles in the tube. At this stage, a chest X-ray may be taken to check that the pneumothorax has healed. The chest drain is usually clamped for a short time before being carefully removed.

A baby may have to be given supplemental oxygen or be gently ventilated because of the pneumothorax. If the baby was already ventilated before the pneumothorax occurred, she may require more oxygen and increased support from the ventilator. Sometimes high frequency jet ventilation is used, especially if there are problems with the pneumothorax. Additionally, antibiotics may be administered to reduce the chance of infection.

Treatment of pneumonia

Pneumonia is an infection of the lung. A foreign micro-organism has invaded the lungs and in response, the lung becomes inflamed and may produce excess secretions. In general, this condition is usually first suspected when there are unexplained signs of respiratory distress. Another sign may also be when a baby fails to respond or does not respond well to surfactant replacement therapy; often, surfactant is inactivated by the inflammatory process associated with infection. A chest X-ray may also reveal patchy changes within the lung. When pneumonia is suspected for any of the above reasons, blood cultures will be taken. However, these laboratory tests may take time and may not be conclusive.

If a lung infection is suspected, doctors will probably not wait for the results of a laboratory test before beginning treatment. Broad spectrum antibiotics, which are antibiotics that target a wide range of possible infections, will be prescribed.

Oxygen may be provided to increase gas exchange in the lung while the infection clears and the lungs become more efficient. Other treatment may include:

  • continuous positive airway pressure (CPAP)
  • mechanical ventilation

Treatment of congenital malformations of the lung

Although rare, there are several types of congenital malformations, also called birth defects, of the lung. The type of malformation will determine the treatment, though in most cases, surgery is the approach to correct the problem. Until the surgery can be performed, breathing is stabilized and supported using the approaches described above.

Treatments for the most common types of congenital malformation of the lung are described below.

Congenital diaphragmatic hernia

Congenital diaphragmatic hernia is a malformation of the diaphragm, the muscle that separates the chest from the abdomen. Usually with this condition, the diaphragm either is missing or has a hole in it. Consequently, the organs in the abdomen, such as the stomach and the liver, can drift into the chest cavity, leaving little room for the lungs to expand during breathing. Repair of the diaphragm is accomplished with surgery.

Cystic adenomatous malformations

Cystic adenomatous malformations are cysts at the end of the small airways within the lung. There is a connection with the airways of the lung that cause the cysts to increase in size. Most babies with cystic adenomatous malformation have respiratory distress. Surgical removal of the affected lobe is the treatment.

Congenital lobar emphysema

Congenital lobar emphysema is a malformation which causes overinflation of one of the lobes of the lungs. This becomes a problem because the overinflated lobe takes up more space than it should and therefore interferes with the regular inflation of the rest of the lung. Again, surgery is the treatment.

Pulmonary sequestration

Pulmonary sequestration refers to an area of non-functioning lung tissue that has no connection to the airways of the lung. The abnormality may be within the lung or outside the lung. A sequestration may be asymptomatic or may cause breathing problems. Surgery is recommended to remove a pulmonary sequestration.

Pulmonary hypoplasia

Pulmonary hypoplasia refers to underdevelopment of the air sacs called alveoli, the airways, and the blood vessels of the lung. There is a spectrum of severity of this abnormality. Babies with severe pulmonary hypoplasia usually do not survive long after birth.

More information

Andrew James, MBChB, MBI, FRACP, FRCPC

Jaques Belik, MD, FRCPC