The pneumothorax, and its often invasive treatment, are impressive events in otherwise healthy young patients. The relationship between smoking behaviour and the idiopathic spontaneous pneumothorax (ISP) is explained to the patients. The objective of the study was to analyse whether smoking behaviour of patients is influenced by the ISP (re-) event, and its treatment. Of 145 consecutive ISP patients (1991-1995), 112 were tobacco smokers at time of the first ISP. Of the 112, 106 participated in a confidential telephone questionnaire survey combined with retrospective medical record analysis. Smoking cessation and reduction percentage related to ISP events, and its treatment, were the outcome measurements. All patients (mean age 28.8 years at the first ISP) were aware of the relationship between smoking, and ISP at time of the first ISP. Age, pack years, and different treatment modalities had no influence on smoking cessation or reduction. Some 86.2% of the male and 80.8% of the female patients continued smoking after the first ISP, despite the known relationship between smoking, and contracting spontaneous pneumothorax, and despite its often invasive treatment. In the group of recurrent pneumothorax events 73.3% continued smoking.