An Audit of medical thoracoscopy and talc poudrage for pneumothorax prevention in advanced COPD

Chest. 2004 Apr;125(4):1315-20. doi: 10.1378/chest.125.4.1315.


Objectives: To prospectively study all patients with COPD and spontaneous pneumothorax (SP) who underwent thoracoscopic talc poudrage (TP) under local anesthesia to determine its efficacy and safety in recurrence prevention.

Methods: Data on clinical measurements, complications, duration of chest tube drainage, length of hospital stay, and outcome were collected.

Results: Forty-one patients (38 men and 3 women) with a mean (+/- SD) age of 70.7 +/- 7.2 years were treated. All patients had COPD, with a mean FEV(1) of 41 +/- 14% predicted. The majority of SPs measured 20 to 50% in size, and 34% were recurrent. Three grams of talc were insufflated into the pleural cavity without complications. Thirteen patients (32%) complained of pain, 5 (12%) developed fever, 27 (66%) had subcutaneous emphysema, and 7 (17%) had prolonged air leaks. Postoperative chest tube drainage and hospital stay were 4 and 5 days, respectively. Success was 95% after a median follow-up of 35 months. Four patients with FEV(1) of < 40% predicted died within 30 days of the procedure, yielding a mortality rate of 10%. FEV(1) (in liters), FEV(1) (in % predicted), and ischemic heart disease were risk factors that influenced early mortality.

Conclusion: Thoracoscopic TP is effective for pneumothorax prevention and can be performed with acceptable mortality in patients with advanced COPD.

MeSH terms

  • Aged
  • Drainage
  • Female
  • Humans
  • Length of Stay
  • Male
  • Medical Audit*
  • Myocardial Ischemia / complications
  • Pleurodesis / methods*
  • Pneumothorax / mortality
  • Pneumothorax / prevention & control*
  • Pulmonary Disease, Chronic Obstructive / complications*
  • Recurrence
  • Safety
  • Talc / administration & dosage*
  • Thoracoscopy*
  • Time Factors
  • Treatment Outcome


  • Talc