Abstract
Background
Recurrent spontaneous pneumothorax rarely occurs in asthma. When an asthmatic patient has recurrent spontaneous pneumothorax, additional predisposing factors need to be considered.
Case Report
We present a case of bilateral, recurrent spontaneous pneumothorax occurring in a male adolescent with chronic atopic asthma. Five episodes occurred during a period of 25 months. He was found to have intermediate alpha- 1-antitrypsin deficiency (protease inhibitor phenotype, PiMS). His father has emphysema and also has the PiMS phenotype.
Discussion
Spontaneous pneumothorax has been reported previously in a 43-year-old man with PiMZ and in a family in which six members had repeated spontaneous pneumothoraces associated with PiM1M2. In addition, another report found elastin and alpha-1-antitrypsin in blebs and bullae from patients with spontaneous pneumothorax.
Conclusions
These reported observations and our case report support the notion that protease-antiprotease imbalance is an important factor in the etiology of spontaneous pneumothorax. This is another reason to consider carefully the anti-inflammatory control of the asthmatic process in children and adults with persistent disease.
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