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University of Cambridge study finds up to one in 100 Covid-19 patients admitted to hospital develop punctured lung

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Up to one in 100 patients admitted to hospital with Covid-19 develop a punctured lung, Cambridge researchers have found.

A team at the University of Cambridge and Addenbrooke’s Hospital observed several patients with the coronavirus who developed the condition, known as a pneumothorax, when hospitalisations due to the pandemic were at their height.

A doctor looking at a chest X-ray (42223635)
A doctor looking at a chest X-ray (42223635)

The condition typically affects very tall young men or older patients with severe underlying lung disease, but was seen in people in neither group on Covid-19 wards.

It occurs when damage to the lung leads to a puncture. Air leaks out, building up in the cavity between the lung and chest wall, causing the lung to collapse.

Prof Stefan Marciniak, from the Cambridge Institute for Medical Research, said: “We started to see patients affected by a punctured lung, even among those who were not put on a ventilator.

“To see if this was a real association, I put a call out to respiratory colleagues across the UK via Twitter. The response was dramatic – this was clearly something that others in the field were seeing.”

After obtaining ethical approvals, Prof Marciniak exchanged anonymised clinic information about 71 patients from around the UK, which led to a study published last week in the European Respiratory Journal.

While it cannot give an accurate estimate of the incidence of punctured lung in Covid-19, tge admissions data from the 16 hospitals in the study revealed an incidence of 0.91 per cent..

“Doctors need to be alert to the possibility of a punctured lung in patients with Covid-19, even in people who would not be thought to be typical at-risk patients,” said Prof Marciniak, who is also a fellow at St Catharine’s College, Cambridge.

Professor Stefan Marciniak, of St Catharine's College, worked at Addenbrooke's during the Covid-19 crisis - and had to shave his beard so he could wear PPE
Professor Stefan Marciniak, of St Catharine's College, worked at Addenbrooke's during the Covid-19 crisis - and had to shave his beard so he could wear PPE

“Many of the cases we reported were found incidentally – that is, their doctor had not suspected a punctured lung and the diagnosis was made by chance.”

The study reported that 63 per cent of patients with a punctured lung survived.

Older age was associated with poorer outcomes. There was a 42 per cent survival rate among older patients, compared to 42 per cent among older patients.

The survival rate did not differ between the sexes, but patients with a punctured lung were three times more likely to be male than female. This could reflect the fact that men are more commonly affected than women by more severe forms of the disease, according to larger studies.

Dr Anthony Martinelli, a respiratory doctor at Addenbrooke’s Hospital, said: “Although a punctured lung is a very serious condition, Covid-19 patients younger than 70 tend to respond very well to treatment. Older patients or those with abnormally acidic blood are at greater risk of death and may therefore need more specialist care.”

It is thought there are several ways that Covid-19 might lead to a punctured lung, such as by the formation of cysts in the lungs, which have been previously observed in X-rays and CT scans.

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