Chemicals for sticking the outer lung surface to surrounding membranes compared to surgery to stop air persistently collecting in the chest

Cystic fibrosis is an inherited disease which irreversibly damages the lungs. People with cystic fibrosis are prone to getting a pneumothorax. A pneumothorax is defined as the presence of air in the space between the two linings of the lungs. It can potentially kill people with cystic fibrosis because of the added stress on the heart and lungs. It can be treated by surgical and non-surgical interventions. However, although these treatments are generally effective, they are far from perfect. Certain treatments work in some people but not others. Also, the treatments do have side effects and can be dangerous for people with cystic fibrosis. Currently, physicians do not know the safest and most effective way of treating pneumothorax in people with cystic fibrosis. We did not find any randomised controlled trials that compared the surgical and non-surgical treatments for pneumothorax in people with cystic fibrosis. Therefore, more research is needed in this field. Future studies should compare the safety and efficacy of surgical and non-surgical interventions for pneumothorax in people with cystic fibrosis. There is currently no research being undertaken in this area. We will continue to search for evidence, but will not be updating the review until we find new evidence.

Authors' conclusions: 

Pneumothorax is a potentially life-threatening complication for people with cystic fibrosis and the management of spontaneous pneumothoraces remains a topic of considerable controversy. Medical and surgical intervention are the two main categories for the treatment of recurrent pneumothoraces in this population. However, it is disappointing that neither intervention has been assessed by randomised controlled trials. This systematic review identifies the need for a multicentre randomised controlled trial assessing both efficacy and possible adverse effects of the use of chemical pleurodesis versus surgical interventions for the treatment of persistent and recurrent pneumothoraces in people with cystic fibrosis.

Due to a current lack of research in this area, while searches will still be undertaken every two years, the review will only be updated if any new evidence comes to light.

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Background: 

Pneumothorax is a potentially life-threatening complication for people with cystic fibrosis. Spontaneous pneumothorax is the presence of air in the pleural space and can be subdivided into first episode and recurrent. The recurrence of pneumothorax is when it occurs on the same side seven days or more after initial resolution. A pneumothorax is persistent if the air leak lasts for more than five days (Schidlow 1993). Managing spontaneous pneumothoraces is controversial and there is no standard treatment. Medical and surgical intervention are the two main categories for the treatment of recurrent pneumothoraces in people with cystic fibrosis. While surgical interventions are felt to be more effective in people without cystic fibrosis, the complications directly related to the procedure, as well as the post-operative complications make surgical interventions riskier for people with cystic fibrosis. Additionally, these interventions have the potential to make people with cystic fibrosis ineligible for lung transplantation in the future. Therefore, the benefits and side effects or disadvantages for the medical and surgical treatment of recurrent pneumothoraces in people with cystic fibrosis need to be systematically reviewed.

Objectives: 

To determine the clinical efficacy and safety of different treatment interventions for managing spontaneous persistent and recurrent pneumothoraces in people with cystic fibrosis.

Search strategy: 

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings.

Date of the most recent search: 29 October 2012.

Selection criteria: 

Randomised and quasi-randomised controlled trials which compared the use of chemical pleurodesis to surgical interventions for the treatment of persistent and recurrent pneumothoraces in CF.

Data collection and analysis: 

No relevant trials were identified.

Main results: 

No trials were included in this review

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