Intrapleural talc for the prevention of recurrent pneumothorax

Our plain-English summary of Intrapleural talc for the prevention of recurrent pneumothorax, by J.R. Milanez, F.S. Vargas, L.T. Filomeno, et al (Chest, 1994).

The study

• Authors: J.R. Milanez, F.S. Vargas, L.T. Filomeno, A. Fernandez, A. Jatene, R.W. Light
• Journal: Chest
• Published: 1994;106(4):1162-5
• Cited by: 45 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The ipsilateral recurrence rate after the first spontaneous pneumothorax treated with tube thoracostomy is reported to be between 23 percent and 52 percent. The incidence of recurrence after the first recurrence is substantially higher. Chemical pleurodesis has been attempted to decrease the recurrence rate. Tetracycline has been widely utilized, but parenteral tetracycline is no longer available. Therefore, alternative sclerosing agents have been used. Talc has been demonstrated to be effective in preventing recurrences and it has minimal long-term effects. This prospective study was designed to determine the efficacy of talc pleurodesis in patients with recurrent spontaneous pneumothorax. Eighteen patients admitted between May 1985 and March 1993 to the Department of Thoracic Surgery underwent thoracoscopy and were treated by tube thoracostomy with chemical pleurodesis. All the patients had had at least two pneumothoraces and six had had at least six pneumothoraces. Sterile asbestos-free talc, 2g, was aerosolized throughout the pleural surface. One or two chest tubes were inserted, left clamped for 2 h, and unclamped after this time. The tubes were removed when no air had escaped for 24 h. Only one (5.6 percent) patient had recurrence of the pneumothorax, and a second insufflation of talc resulted in no new recurrence after a follow-up of 10 months. The remaining 94.4 percent did not have recurrence of pneumothorax within an observation period of 38.5 +/- 28.1 months. The follow-up was more than 2 years for 66.7 percent with no recurrence and was more than 5 years for 33.3 percent. We conclude from these observations that the insufflation of 2 g of talc into the pleural space is a safe effective treatment for control of recurrent spontaneous pneumothorax.

In plain English

This was a small prospective series of 18 patients (9 men, aged 15 to 62) with recurrent spontaneous pneumothorax, a collapsed lung that keeps coming back. They were admitted to a Department of Thoracic Surgery between May 1985 and March 1993. In 17 patients, doctors passed a scope into the chest (thoracoscopy) and sprayed 2 g of sterile, asbestos-free talc over the chest lining. In the other patient, thoracoscopy found a large lung cyst, so talc was applied during open chest surgery. There was no comparison group. One of the 18 patients (5.6 percent) had a recurrence, 15 days after treatment. After a second talc treatment, that patient had no new recurrence over 10 months. None of the other 17 had a recurrence over an average follow-up of 38.5 months (range 4 to 89). Two patients had severe pain right after treatment. The authors reported no long-term adverse effects and no pleural thickening on chest X-rays. The study did not examine asbestos-related disease. The authors concluded that 2 g of talc was a safe, effective treatment for recurrent spontaneous pneumothorax.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: prospective case series (single treated group, no comparison group)
• Who was studied: 18 patients with recurrent spontaneous pneumothorax, 9 of them men, mean age 35.6 plus or minus 13.3 years (range 15 to 62), admitted to the Department of Thoracic Surgery between May 1985 and March 1993. The authors' affiliations include the University of Sao Paulo, Brazil. All had previous episodes on the same side, and six had at least six such episodes.
• Exposure: Sterile asbestos-free talc (purchased from Labormax, Brazil). In 17 patients, 2 g was aerosolized into the pleural space through a thoracoscope. In one patient, thoracoscopy found a large apical cyst, and that patient instead had talc insufflated during a subsequent thoracotomy.
• Main results:
  • 1 of the 18 patients (5.6 percent) had a recurrence, 15 days after treatment. After a second talc treatment, that patient had no new recurrence during 10 months of follow-up.
  • None of the remaining 17 patients (94.4 percent) had a recurrence over an observation period averaging 38.5 plus or minus 28.1 months (range 4 to 89). Follow-up was more than 2 years for 12 patients (66.7 percent) and more than 5 years for 6 (33.3 percent).
  • All patients received a posterior chest tube, which stayed in for an average of 4.9 plus or minus 2.3 days (range 3 to 12). Three patients (16.7 percent) also needed an anterior chest tube.
  • Two patients (11.1 percent) complained of severe pain immediately after the talc. No respiratory distress syndrome or pneumonitis occurred.
  • No long-term adverse effects of talc were reported in this series, and there was no evidence of pleural thickening on chest radiographs.
  • One patient with a large apical cyst found at thoracoscopy went on to thoracotomy, with talc insufflated during the surgery. The other 17 had only thoracoscopy plus talc.
• The authors' conclusion: The authors concluded that insufflating 2 g of talc into the pleural space is a safe, effective treatment for controlling recurrent spontaneous pneumothorax. They recommended the 2 g dose.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Talc, Pneumothorax, Pleurodesis, Talc Pleurodesis, Thoracic Surgery, Thoracoscopy, Asbestos-Free Talc.

Related studies

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• A randomized controlled trial of the efficacy of cosmetic talc compared with iodopovidone for chemical pleurodesis — R. Agarwal, A.S. Paul, et al. (2011)
• Lung function 22-35 years after treatment of idiopathic spontaneous pneumothorax with talc poudrage or simple drainage — P. Lange, J. Mortensen, et al. (1988)
• Talc Pleurodesis: A Medical, Medicolegal, and Socioeconomic Review — I. Baiu, E. Yevudza, et al. (2020)
• Recurrent pneumothorax following abdominal paracentesis — P.J. Stafford (1990)
• Medical thoracoscopic talc pleurodesis for chylothorax due to lymphoma: a case series — D.C. Mares, P.N. Mathur (1998)

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