PT - JOURNAL ARTICLE AU - Luke Mcdonald AU - David Berlowitz AU - Mark Howard AU - Linda Rautela AU - Caroline Chao AU - Nicole Sheers TI - Pneumothorax in neuromuscular disease associated with lung volume recruitment and mechanical insufflation-exsufflation AID - 10.1183/23120541.RFMVC-2020.07 DP - 2020 Feb 13 TA - ERJ Open Research PG - 07 VI - 6 IP - suppl 4 4099 - http://openres.ersjournals.com/content/6/suppl_4/07.short 4100 - http://openres.ersjournals.com/content/6/suppl_4/07.full SO - erjor2020 Feb 13; 6 AB - We present a review of the literature and two case studies of pneumothorax associated with lung volume recruitment (LVR) or maximal in-exsufflation (MI-E).Case 1: 71-year-old male with MND presented with worsening dyspnoea & chest pain immediately following LVR therapy. Chest radiograph revealed a large right-sided pneumothorax.Case 2: 25-year-old male with Duchenne muscular dystrophy presented with chest pain & dyspnoea secondary to a large right-sided pneumothorax. Onset of symptoms began following prolonged use of mouthpiece intermittent positive pressure ventilation and multiple sessions of MI-E.Literature Review: The prevalence of people with neuromuscular diseases who are on home mechanical ventilation is conservatively estimated at 3 people per 100,000. Within this small population very few cases of pneumothorax have been published, and there are no published data identifying lung function thresholds or respiratory system compliance values that have been associated with an increased risk of pneumothorax with LVR and/or MI-E use.Discussion: It is unlikely that robust measures for pneumothorax risk can be developed and prospectively validated for such a rare complication. As such, clinicians must decide whether therapy is justified based on the patient’s current presentation, primary pathology, comorbidities, likely disease trajectory, aim of LVR or MI-E therapy and ability to perform the techniques safely. The presence of prior pathology is a precaution that warrants careful consideration. Where no established risk factors exist, clinicians should consider the goals of therapy and discuss the risks versus benefits with users.FootnotesCite this article as: ERJ Open Research 2020; 6: Suppl. 4, 07.This is an ERS Respiratory Failure and Mechanical Ventilation Conference abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).