The Pneumothorax And Symptom Evaluation (PASE) Study: Bendopnoea in patients with pneumothorax

Participants will undergo the below assessments once at baseline, and in those patients who receive air drainage/lung re-inflation as per standard care and treating physician, they will repeat the below assessments one more time post lung re-inflation. Air drainage and lung re-inflation is at the discretion of the treating physician and is not a trial related intervention. The delegated study team will undertake and administer all the below assessments. All assessments will take approximately 20-25 minutes in total. 1. Bendopnoea test. The patient is sitting in a chair and is instructed to bend forward at the waist and aim to touch his/her ankles and maintain this position for up to 60 seconds. Patient will inform the investigator as soon as breathlessness bending forward (i.e., bendopnoea) occurs, The test will end as soon as symptom onset. Patients will be instructed to inform the staff member if they feel dizzy or lightheaded, and if so the test will be ceased. 2. Bendopnoea questionnaire. In a qualitative manner with the following question: “Since the onset of your symptoms, how has shortness of breath when bending forward impacted your day-to-day activities?” i. No limitation: I was not troubled by breathlessness when bending forward ii. Mild: I felt breathless when bending forward and performing an activity (e.g., tying shoelaces) but can still perform activities without limitation or rest. iii. Moderate: I had to stop and take breaks from bending forward to complete what I wished to do (e.g. I have to bend down several times to complete tying the laces of both shoes). iv. Severe: I was too breathless to bend forward b. After the air drainage procedure, the question will be phrased: “since the procedure, how does shortness of breath when bending forward impact your day-to-day activities?” 3. Breathlessness questionnaire (Visual Analogue Scale). Breathlessness will be measured using a 100mm visual analogue scale (VAS) anchored by “no shortness of breath at all” and “maximum shortness of breath”. The mean of the VAS scores measured by two independent researchers will be documented. 4. Pain questionnaire (Visual Analogue Scale). Pain will be measured using a 100mm visual analogue scale (VAS) anchored by “no pain” and “worst pain”. The mean of the VAS scores measured by two independent researchers will be documented. Patient characteristics. Breathlessness can be a result of concurrent illnesses (e.g., heart failure, COPD etc) and intrathoracic (e.g., pulmonary emboli) or extrathoracic factors (e.g., muscle wasting) which will be captured from case notes. Height, weight and body mass index will be recorded. Cardio-pulmonary status (respiratory and heart rates, blood pressure and oxygen saturation) and the aetiology of the pneumothorax will be recorded. Pneumothorax Characteristics The size of the pneumothorax will be measured on standard erect PA inspiration chest radiographs (CXR) with the Light Index and Collins Method. The Light Index measures the average diameter of the lung and the hemithorax, cubing these diameters, and finding the rations whereas the Collins Method calculates the ‘sum of interpleural distances’ which estimates the pneumothorax size.