How should a larger pneumothorax, defined as greater than 20% lung collapsed, be treated?

A larger pneumothorax, defined as greater than 20% lung collapse, typically requires intervention beyond conservative measures. The primary goal is to re-expand the lung and alleviate symptoms, which can include dyspnea and chest pain. In this case, the preferred approach is either chest tube evacuation or needle aspiration.

Chest tube placement allows for continuous drainage of air from the pleural space, facilitating lung re-expansion. It is particularly effective in larger pneumothoraces, as it provides a more definitive treatment compared to simpler methods. Needle aspiration can serve as a temporary measure to decompress the pleural space in cases where immediate intervention is necessary.

Other options, such as only using oxygen therapy, do not address the issue of excess air in the pleural cavity and may lead to worsening symptoms without resolving the underlying cause. Antihistamines and rest do not provide any therapeutic benefit for pneumothorax since they are typically used for allergic reactions and have no role in managing collapsed lung tissue. Strict bedrest may provide some comfort but does not actively treat the condition, making it an inadequate choice for managing a significant pneumothorax.