An estimated 20,000 new spontaneous pneumothoraces occur each year in the United States, and there is evidence that the rate is increasing. 12 However, the true incidence of spontaneous pneumothorax is unknown, with estimates that up to 20 percent of such patients do not seek medical help. 3 Spontaneous pneumothorax is primarily a disease of male smokers who have larger height-to-weight ratios.4 Male sex carries a 6:1 relative risk compared with the risk for females, although more recent studies show a trend to increased cases among women, perhaps due to smoking trends.2 Smoking is an important risk factor with an overall greater than 20:1 relative risk compared with nonsmokers.5 Spontaneous pneumothorax occurs among all age groups, with three peaks: among neonates (due to hyaline membrane disease or aspiration), among 20- to 40-year-olds (such cases tend to be primary), and among those older than age 40 (typically secondary cases). A genetic component is evidenced in the 11 percent of patients who have family members with spontaneous pneumothorax.6 Contrary to common belief, only 10 to 20 percent of cases occur with exertion.4 Spontaneous pneumothorax may rarely be associated with menses (catamenial).4

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