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Pneumothorax complicating asthma — RACP Paediatrics MCQ

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HardRespiratoryPneumothorax complicating asthmaRACP Paediatrics

A 13-year-old with an acute asthma exacerbation develops sudden pleuritic pain and worsening hypoxia while receiving nebulised salbutamol. Breath sounds are markedly reduced on the right and the trachea is central. Chest X-ray confirms a moderate right pneumothorax. What is the most appropriate management?

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Correct answer: D — Intercostal catheter drainage with senior respiratory input

The child has symptomatic pneumothorax with hypoxia during an asthma attack, requiring drainage and senior review. Observation may be reasonable for a small, asymptomatic pneumothorax, but not with worsening oxygenation. Asthma can mask the diagnosis, so sudden asymmetry or pleuritic pain should prompt reassessment.

Reference: RCH Acute asthma guideline; RCH Pneumothorax guidance