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Primary spontaneous pneumothorax (PSP) is not a particularly dangerous condition. Tension pneumothorax in the setting of PSP is extremely rare and mortality of PSP is negligible.1 Several series about conservative treatment with good results were published long ago.2 3 In spite of this, in hospital management with under water sealed intercostal tube drainage became widely used from the 1970s onward. At the turn of the centuries, two randomised (pilot) studies suggested that manual aspiration in comparison with intercostal tube drainage was safe and resulted in less days in hospital and less pain.4 5 Their impact on the management of PSP however was moderate and although guidelines mentioned conservative management and manual aspiration, hospitalisation with intercostal tube drainage still remained widely practised.
Two decades later, two studies were published that can be regarded as the first adequately powered multicentre randomised controlled trials on the management of PSP.6 7 The primary spontaneous pneumothorax (PSP) trial studied the conservative management of PSP versus small-bore (≤12 …
Footnotes
Contributors JMAD conceived and wrote the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.